Wednesday, June 30, 2010

Becoming Experienced

Transferred from http://en.wi...
Here's the difference between Dante, Milton, and me. They wrote about hell and never saw the place. I wrote about Chicago after looking the town over for years and years. ~ Carl Sandburg
It's not fair, I realize, but there's nothing to be done about it. Since we can't speed up the clock, we just have to put up with it, and besides, if we rush, once we get there, we'll wish we'd taken our own sweet time. Oh, and then we'll be p.o.ed because we missed out on a ton of good stuff along the way. I'm talking about gaining experience. When we don't have any, we want it, though in order to obtain it, we may have to get run through the ringer. Not every time, thanks be to God, but with enough regularity that it's worth writing about this morning.

You see, the problem with becoming experienced is, we get experience. For instance, drug and alcohol counselors often have a personal history of substance abuse. Now, nobody in their right mind becomes an alcoholic in order to counsel with other alcoholics. Wait, I take that back, I've known a few narcissistic types who were sufficiently inflated and insight-less to try. But for the most part, while those who have a substance abuse background value what they've learned, they're not proud of the way in which they learned it.

Then there's the idea of vicarious experience, which is another way of saying we learn by observation. Medical students know a lot about this one. We "assist" in surgery, for example, by holding a retractor and watching while the doctor dives into an incision, in order to benefit from her experience. You wouldn't list this on your resume, but being present and having something to do with your hands besides keeping them folded so you don't inadvertently contaminate anything important -- like the patient -- is one way of learning.

And theoretically, it contributes to a body of knowledge that we can use as a guide to reduce the number of mistakes we'll eventually make on our own, mistakes that have the nasty habit of constituting real experience. Thankfully, there's more to this process than making mistakes or getting into trouble, but occasionally that's how we figure out how to identify and stay away from them. Though not always.

Growing up around large animals, my father taught me to never allow a horse to get ahead of me on lead. In other words, make sure I walked next to his head rather than behind it. Naturally, being young and invincible, I figured his advice was for the old and feeble. Then came the cold, snowy afternoon when I was drug 50 feet by our usually well-mannered Appaloosa stud horse and my left hip became unpleasantly acquainted with his left rear hoof. The bruise was the size of a watermelon and I limped for days. Let's say I never made that mistake again. Chalk up another one for the Old Man.

Sandburg had a point (see quote), it's one thing to talk about hell and another to spend your days and nights wondering what in the hell you did to get yourself there in the first place. Which wrong turn did you take, which right one should you have taken, and why didn't someone tell you about the fifty two warning signs (billboard sized) printed in black, block capital letters on fluorescent orange in plain English posted at regular intervals on your side of the road? Honestly, there are days when we just can't see them, not even if we've stopped, gotten out of the car, walked up, and stuck our noses against them. For good or ill, we have to drive off the precipice, blind as bats until we hit bottom. And then we have experience.

(GNU Free Documentation image via Wikipedia)

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Tuesday, June 29, 2010

Moonlight and Seduction

Dracula (first edition cover), Bram Stoker's v...

Moonlight, seduction, long, sharp upper canines and, no, they don't belong to my dog. They do, however, find a place in nearly any film about vampires, especially seduction, and not simply because it's an opportunity to feature Hugh Hefner's newest girlfriend in a starring role. There is something distinctly sensual in the vampire myth and it goes back at least as far as Bram Stoker's 1897 Dracula.

According to William Patrick Day, Dracula is a sexual predator, and in the Victorian era, his tale was a cautionary one about the dangers of sex and the loss of soul that accompanies giving oneself over to unbridled desire. We could easily reinterpret this, and some writers do, as the loss of self through addiction. Personally, I'm inclined to take the sexual element as representing innocence and susceptibility to suggestion.

Think about it: how often do you see vampires depicted frequenting ladies of the evening? Usually victims are young, sweet, lacking in worldly wisdom. With male victims, power seems to be the overriding theme. With women, it's the ravishing of the virgin. In both cases, vampires are drawn to individuals whom they perceive to be vulnerable. And one is never enough; vampires are insatiable.

In this respect, it's relatively easy to use the vampire as a metaphor to conceptualize persons who are famished for mirroring and adoration. Loving only themselves, if love we may call it, they move from one victim to the next, draining them of self-esteem, wearing them out like a nagging mother-in-law wears out her welcome. Intolerant of equals -- and for them, there is no equal to themselves -- they accumulate minions and admirers to bask in the glow of their grandiosity.

If one is unfortunate enough to be the significant other in a relationship with someone like this, forget about being cared for, because your needs don't compare with those of your partner. In the event your partner is a closet vampire, your image will be crucial to them, but it's only an image and as my grandmother used to say, "good looks only last so long and then you find out what your relationship is really made of."

We generally don't like to think of ourselves as vulnerable or innocent, but social vampires seem to possess an inner radar that enables them to hone in on potential victims. They tend to be practiced in the arts of deception and concealment. Being the object of attention is seductive and not wishing to appear ungracious, we resist looking the gift horse in the mouth. The problem is, failure to do so can lead to getting bitten -- in more ways than one.

(Public Domain image via Wikipedia; William Patrick Day, Vampire Legends in Contemporary American Culture, University Press of Kentucky, 2002)
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Sunday, June 27, 2010

It's All About Angular Momentum

RumbaImage by Krypto via Flickr

I miss the sound of your voice, and I miss the rush of your skin, and I miss the still of the silence as you breathe out and I breathe in. ~ Come On Get Higher

I don't know if I can describe what I felt last night, but I think the lyrics I've just quoted come close. We were learning the Rumba, an incredibly sensuous style of dancing from Cuba, and there were moments when it seemed as though my partner and I were like magnets, being held at opposite poles. Have you ever done that? Situate two magnets so they push one another by unseen forces? Do you remember the feeling transmitted to your fingers, almost a living, organic, give and take between them? It was like that.

And it happens most often in the turns, when movement combines with velocity in a circular direction creating angular momentum, swinging us from one place to another. The seconds slow and it's as though we're moving in the space between them. The instructor's voice interrupts, my partner smiles, I breathe a rush of air, and we start again.

Times like this I begin to realize how Eliza Doolittle could have "danced all night," (My Fair Lady) though I'm sweating through my shirt from the effort of start and stop, repeating each phase two-three-four times to get it right, always with a different partner. One commiserates gently, "It must be hard for you, being one of the few men. We get a break, but you don't." I don't mind, I say, because it's part of my "workout," but it's more than that, it's as though one breathes out and the other in, it's a dynamic that flows even between those who will remain strangers at the close of the evening.

Eliza was in love with the older, professorial Henry Higgins, whose acquaintance with angular momentum, not unlike mine, was as an intellectual construct. We can explain, draw, and detail its effects, but being a part of it, one earth-bound celestial body with another -- Carl Sagan said it, we're made of star stuff -- was as alien as Eliza's Cockney at the royal court. Once you've felt it, words become inadequate to describe it, and honestly, it's a little addictive.

Working with relationships professionally, you become familiar with quantifying and qualifying, diagnosing and prescribing, a scientist of the human heart. Those instants of grace, however, when you're caught up in something that lifts you out of your head, are like Eliza, rescuing Henry from himself and teaching him how to live. They show us how little we really know and how much we have yet to experience.

(Creative Commons image of couple dancing the Rumba by Krypto via Flickr; Come On Get Higher, lyrics by Matt Nathanson and Mark Weinberg, copyright 2007 )

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Saturday, June 26, 2010

Proving a Point

Formula One 2006 Rd.18 Interlagos: #5 Michael ...
Before settling down to write this morning, my cat and I were watching the qualifying runs for the European Grand Prix in Valencia, Spain, over coffee. Well, let's put it this way, I was watching and he was getting his morning dose of lap time (no pun intended). One of the great things about this season's racing has been the return of seven-time world champion Michael Schumacher to the scene after a three-year "retirement."

You'd think someone with his experience would have a fairly easy time taking the lead in the championship standings, but that hasn't been the case. For one thing, he's driving for a new team, Mercedes-McLaren rather than Ferrari, and this weekend, he's racing on a course he's never driven before. Tire and auto technology have advanced since he retired, and now he's facing a learning curve similar to the one confronting younger, as well as newer, drivers.

During his final lap in the qualifying heats, he was informed by his mechanics team (two-way radios are standard in Formula One) that there was a problem with his power steering and he was asked if could he finish. Silence from Michael as he pushed his car faster and ended up in the top grid. Said one commentator with a chuckle, "I guess that's his answer."

I love seeing a veteran doing what s/he loves and making a comeback. And particularly so when his position in the standings doesn't place him anywhere near the lead. I'm guessing he got plenty of advice, before deciding to return to racing, that suggested this was a risky venture. To begin with, he's older, he's out of practice, and he has his reputation to think about. Did he really want to appear like a former champion who didn't know when to quit?

Apparently, he's got sufficient ego strength and self-awareness to take that risk for the sake of living the life he values the most. He may be like Lance Armstrong, who has begun racing again simply because he loves it. Winning is fine, but he's riding for deeper reasons, to achieve fulfillment, to be his very best self.

Formula One is an expensive enterprise and while having Michael on the team is good PR, sooner or later he's got to pay the rent. I feel certain he knows this and fully intends to do so, leaving those who said he should be cautious to think again.

Sometimes you just have to prove a point.

(GNU Free Documentation Image via Wikipedia)

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Friday, June 25, 2010

Bat Bleep Crazy

NYC - MoMA: Jackson Pollock's One:Number 31, 1950

I used to think it was a liability associated with being a minister, but now I know it's simply a fact of life. People assume you're interested in morality and ethics because anyone who pursues a professional relationship with God is likely to be the kind of person who prefers to stay within the lines while coloring. You know what my problem was? I could never quite do that. My crayon books would have made Jackson Pollock proud (see photo). I wasn't being stubborn as a kid, or independent, or recalcitrant, I just couldn't keep my crayons between the lines to save my life.

I should have known this was a portent of things to come, but as a second grader, my vision of the future had a somewhat narrower focus, i.e. how many more weeks is it until Christmas? I'm still that way, as you may have guessed from the litter of holiday essays I manage to produce between Halloween and December 25. I mean, here we are, it's not even the end of June and I'm talking about it already. But this post isn't about Christmas. It is, however, about morality, ethics, and a disinclination to stay within the lines.

The reason I say this is partly due to the fact I have trouble seeing them. The lines aren't as distinct as they were in my coloring books depicting black ink on white newsprint outlines of Mickey Mouse and Donald Duck. It's not a matter of eyesight because mine has improved substantially over time to my doctor's amazement. It's really a matter of experience, and discovering that human nature needs grace most of all. Legislated morality is an open invitation to go bat bleep crazy.

A good friend of mine, now in his first week of residency, passed along a wonderful comment he overheard the other day: "Make sure you know the rules inside and out so you can discern when and how to break them." Some folks are very good at telling others what they should or shouldn't do and justifying it on the basis of any number of social considerations. What I've found, over the course of more years than I'd like to admit of doing pastoral counseling and psychotherapy, is that most people genuinely struggle over poor decisions or relationships gone sour.

It isn't that they want to screw up, but things happen that no one can anticipate. Life is far more complicated than a "do this and not that" orientation can manage. The gray areas are as common as frost heaves on a Maine country road after a hard winter, and believe me, frost heaves are really common. One can't always know with absolute or any other kind of certainty what is the best thing to do.

I'm bringing all of this up this morning because I'm thinking about all my friends who have begun residency this week. Technically speaking, they're involved in orientation meetings and the real work of doctoring starts next week. But eventually, they are going to be confronted with decisions that aren't crystal clear and situations they've never encountered before. They'll have the support of attending physicians, senior residents, and hospital staff, thankfully, but they'll still have to wrestle with the necessity of integrating training with conscience.

As they do, as we all do, I hope they find the grace of self-forgiveness in the process. No one is omniscient, everyone makes mistakes, rigidity breaks rather than strengthens the flailing heart. Granting oneself permission to ask for help, to be less than perfect, to be less than God-like, is the blessing of being human. We do far better seeking grace with every step we take, as my friend John Denver would say, and it's how we make ourselves better at the same time.

(Image of unknown license by Wallyg via Flickr; Rocky Mountain High, words and music by John Denver, copyright 1975)

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Wednesday, June 23, 2010

Hayfield by Ralph Lauren

Yesterday was the first day of haying season. That means it's also the beginning of sinus headache season in my neck of the woods. For the next few days I can count on waking up feeling like my brain has turned into a bowel of overcooked oatmeal. Whoever invented the term "hay fever" obviously lived on a farm. It seems like every bit of pollen and dust stirred up by the tractor-towed bailing machine gets picked up by the fog rising from the river around midnight and then deposited at my doorstep.

Thanks to the rapid intervention of ibuprofen, the discomfort is not long-lived, and it's really worth the inconvenience. I love country life, having been raised in the country, and once the hayfield has been cleared, my dog and I can happily walk the perimeter. He loves the wide open space scattered with the remnant scents of woodchuck, deer, and wild turkey mixed with freshly cut grass. Actually, that sounds like a formula for cologne: Hayfield by Ralph Lauren.

Can't you see the ads? A strapping young (why are they always young? I'd vote for a little gray hair and some character if I was producing it) fellow steps off his tractor and strips off his t-shirt to wipe the sweat from his tanned, handsome (naturally) face and muscular chest (six-pack abs, of course), before sweeping a beautiful young female model in a white and yellow-flowered sun dress into his arms. The camera pans to a deer raising its head from the grass to watch, then to a woodchuck and turkey who do likewise. Back to the couple again, now gazing into the sunset, as the voice of the announcer comes up, "Hayfield, for the farmer in every man."

No? Oh well, can't blame a guy for trying. Anyway, the first year we lived here, we were hesitant about walking the field because of the poison ivy that proliferates around the edges. Either we've become immune or it's not as virulent as I feared, because we've yet to have a close encounter with contact dermatitis (the condition that results from poison ivy). The worst thing now are the black flies, little stealth bomber-shaped beasts that view any warm-bodied creature as fair game. Deep Woods Off is our friend.

Yesterday, some of my classmates took board exams and my date is a mere 29 days away. Another month and the hayfield will have grown deep enough for a second cutting. One more, it will be late September with the trees turning. When I was a kid, stories of rural life ruled by the change of the seasons had a strong appeal for me. I guess that's one of the things I love most about Maine, people are still connected to farm life -- even those in the cities who come out for apple picking or Maple Syrup Sunday in the spring. Mr. Timex or Miss Rolex can mark the minutes all they want, but Mother Nature still owns the time clock.

(Photo copyright 2010 by the author)

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Monday, June 21, 2010

Metabolizing Our Parents

Mountain pine beetles killed these Lodgepole P...

"Like the pine trees lining the winding road, I've got a name, I've got a name...and I carry it with me like my daddy did, but I'm living the dream that he kept hid..." ~ Jim Croce

I just realized, a few moments ago, that I've had these lyrics all wrong for years. I always thought, thanks to the sound quality of my car stereo, that Croce the Younger was living a dream that was impossible for Croce the Elder, because the latter had died ("that he can't live"). Change two words and an entire song takes on new meaning. The life chosen by the son was a dream shared by father and son, though only one of them pursued it.

There's always the temptation to idealize someone after they're gone, overlooking faults and character flaws to create in our minds the person we wished they were, rather than the all-too-human one we really knew. I try to be careful, when writing about my father, to avoid that -- on the one hand, it doesn't do me any good and on the other, it creates a false image of the person he truly was.

I'm bringing this up since, like most guys, I find myself resembling my father as time goes along. It could be argued that it's the act of contemplation that results in likeness, and if that's true, then contemplating his positive attributes is definitely better than the other way around. For the most part, though, I think it's unconscious and I'll express one of his mannerisms unexpectedly. Fortunately, he was a handsome man and became more so with age, so at least I don't have to worry about turning into an ogre when I'm 99. Thank God for small blessings.

When it comes to the hidden lives of fathers -- or mothers, for that matter -- children can be in an awkward position. One of the developmental tasks of adulthood that seems to come up consistently in therapy is the reconciliation of who we've become or wish to become with some critical aspect of the unlived lives of our parents. Even if mom or dad never said a word, children pick up on the ways their parents have been frustrated, unsatisfied, or felt life had passed them by.

I'm not entirely sure it's a bad thing to try to redeem one's parents in the sense that having internalized some aspect of their experience, we've taken it in our own direction. True, some things can be dysfunctional as well as functional, the former usually being to blame for getting people into therapy. But because parents are a part of us, we can't excise their influence as easily as a surgeon removing a blown and ruptured appendix. For good or ill, we have to deal with what we've taken in so that it is a more accurate representative of us as persons.

I have an idea most of us do this without thinking about it. We marry, have children, become proficient in a career, and come to grips with mom and dad along the way. But when circumstances intervene and one or both parents are taken from us, the natural course of events may be altered. In those situations, we don't have presence to guide us and we have to rely on instinct and self-awareness. It seems unfair, our children don't have one pair of grandparents to look up to, but if we've done the work of "metabolizing" and reintegrating mom and dad into our own identity, the kids will have them, because they'll have them through us. And so will we.

(Public Domain image via Wikipedia)

Sunday, June 20, 2010

Medical Boards and More: A Father's Perspective

Fathers Day

Two days away from my original "second date" with our osteopathic medical board exams, it's also Father's Day and I'm wondering what my dad would have to say. Knowing him (and me), probably several things (like father, like son), but I have no doubt he'd begin with, "Don't worry, I've prayed about it and you're going to do fine."

My father wasn't always "religious," you know. If he were here to tell you, he'd admit freely he had little use for religion and even less tolerance for ministers as a younger man. But it wasn't age that changed him, it was the awareness that the vertical dimension to life is as significant as the horizontal one. After my mother died and he was diagnosed with pre-leukemia, his faith grew immensely, so if he said he prayed for you and you were going to be all right, he was certain even if you weren't.

After providing encouragement (
encourage was his favorite word) and reassurance, he'd say, "Now, that doesn't mean you don't need to buckle down, just don't make yourself sick in the process. Have some fun, even if it's only for an hour a day." From someone who rarely practiced the principles of a balanced life, this alone is huge. He learned a lot from his illness, things he wished he'd known years before, but he also knew regret could be poisonous, so he focused on the present and lived for the future.

As far as my decision to push back my exam date an additional thirty days to reinforce my preparation is concerned, I can hear him: "Don't beat yourself up. You took a long, hard look at where you were, where you wanted to be, and said, 'I'm not quite ready.' Better over-prepared than under. Being honest with yourself instead of covering up the truth for the sake of pride or what other people think, is the first step toward getting things right." I couldn't have said it any better.

Finally, he'd remind me why I got into medicine. "I knew all along you were cut out for the ministry, just not the pastorate or at least not forever, but you had to sort that out for yourself. Some things no one can do for us. Not even fathers and sometimes, especially not fathers; it's all part of growing up. You found your place -- you were my 'doctor' when I was on my death bed, remember? So go ahead, fulfill your calling. Be the person you were meant to be."

My father will have been ten years gone this November 5th, but many of the words I've put in his mouth he actually said at one time or another, in one way or another. I was watching the movie
Transformers the other evening and in the scene where the main character's father wishes to buy his son a clunker for his first car, I was reminded of the way my father handled a similar situation. I'd just got home one afternoon -- in November, interestingly enough -- from college when he took me to a local dealership saying he'd found a car, a 1966 Mustang that I've written about previously (see 10/13/09).

My point is, dad consistently remembered what it was like to be me, even when I managed to forget. He taught me that stability is a value to be nurtured in myself and discovered in others. He also taught me nothing can replace it -- not looks, money, intelligence or influence. Someone who can be relied on in a pinch is worth more than a million promises from someone who never shows up. And dad always showed up. So, today I'm remembering the stability and encouragement he'd pass along as easily as one might take keys from their pocket, as though he had a pile stashed somewhere and was ready to hand it over without a second thought.

Happy Father's Day.

(Creative Commons image by loswl via Flickr)

A Congregation of Incongruities

West Mitten Butte Monument Valley, view northe...
"It's butaful," she said, "utterly butaful."

"Didn't you mean to say, 'beautiful?' he asked.

"Your grammatically-correctness is showing," she responded, mockingly, "and no, I meant to say what I said. But-a-ful as in butte-uh-full. Not that prissy beyou-ti-full nonsense."

"You've never been the same since that trip to the Southwest, you know. First, it was 'kick butte,' then 'I've got to put on my buttes before going out,' and now this. What's next, shaking your butte-y when we go dancing?"

"Perhaps. Either way, it's my prerogative. A woman can adjust language to suit her mood and I am a woman, in case you haven't noticed."

"I've noticed, all right and usually, the mystery alone is enough to keep me from saying anything, but now and then I forget and this is one of those times."

"I'll forgive you," she said, sweetly, "men can only be expected to hold one or two incongruities in their heads per year and this is your third for the month."

"That's thoughtful," he responded, "one or two I can handle, but a congregation of incongruities -- and that's what it looks like this is turning into -- gets unwieldy. Do you think you can hold off a bit before introducing another?"

"Only if you say the magic word. Women everywhere are counting on me, you know," she said, teasing him in the way he could never resist.

"Ah, yes, the magic word," he said thoughtfully, trying to give as well as he'd gotten, "Let's see, is it wingardium leviosa? No? How about petrificus totallis? Not right, either. Mm, let's about 'please?'"

Her smile said all he needed to hear.

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Saturday, June 19, 2010

Disposition and Self-Definition

Ebb Tide at Four Mile Bridge.

Is it our disposition in life that defines us or do we determine our disposition based on the persons we are?

I've gone round and round with this, pretty much as my friend and newly graduated medical student cum medical resident, intended. He does that now and then, messing with me, all in fun. I mean, there I am, studying like my life depended on it, and out of the tall grass on Facebook he pops, posing a question he thinks will make me contemplate my place in the universe. Times like this, I've wondered if he shouldn't have studied astrophysics alongside medicine, but that's an inside joke to which I have yet to figure the punchline. When I do, I'll let you know.

In the meantime, let's begin by rephrasing the question. Is our disposition in life the defining principle of our lives, or do we define our disposition, and if the latter, on what basis? When I was in college -- the first time -- I had a chance to serve as a minister at Denver's Salvation Army Harbor Light mission. In those days, lower downtown seemed pretty much reserved for the poor, dispossessed, and homeless. Some of the guys I worked with, guys who smelled of stale alcohol mixed with body odor, had been attorneys or doctors with families -- once. One thing led to another, their wives left them, took the kids, the house, and the Mercedes, and dad ended up with nothing.

Were their lives a wreck because they lived on the street or had they made mistakes and now this was their life? A little bit of both, probably, but I'm betting none of them had the ambition of becoming a street person as a child. Their disposition had changed around them and it became so overwhelming that the good ship Minnow with its captain and crew of one, was lost.

Genetics exerts a powerful effect, but I'm still one of those who believes psychopathology can happen to pretty much anyone. Under the right circumstances or if circumstances persist long enough, even the most tried and true may find their disposition so unsettling their ability to cope breaks down, like a car at the moment the warranty has expired. Resilience has its limits and simply because one hasn't run aground, doesn't mean they can't or won't.

I know, I haven't yet answered the question, or at least to my own satisfaction. I think it's because the line between my disposition and self-definition is not always easily discerned. Who I am as a person is an ongoing interplay between my genetic composition, my history, and the struggle to transcend and/or transform them. My disposition is a complexity composed of choices I've made and/or accepted, some I value and some I'd like to abandon. It's a complexity complicated by the choices of others, some of which I value and some I'd like to abandon.

As a result, neither my disposition nor my self-definition are cut and dried and that's a good thing, because cut flowers, pretty as they are, don't live very long. Dried ones, neatly pressed between the pages of Webster's dictionary, are fragile, and life is not always generous where fragility is concerned. So I hold onto what I know of myself, trusting my grip is strong, and at the same time, try to view my disposition as an opportunity to learn when and how to let go, because even the strongest grip needs a break once in a while. And maybe it's in the ebb and flow of grasp and release that we find the self-definition that works best, especially when circumstances wash over us, like high tide splashing and crashing daily, all along the beach.

(Creative Commons image via Wikipedia)

Thursday, June 17, 2010

No Miracles Here

A box of Risperdal tablets

I saw him masturbating through the eight-inch square, reinforced window in the door to his room while doing 15 minute patient checks. He was in seclusion because, despite the tempering effect of antipsychotic medication, he wasn't convinced we weren't phantoms. Sweet sixteen and muscular, when he was admitted days earlier, he was four-point restraints, tied as securely, we hoped, as a calf in a rodeo roping event. Now off restraints, he was still unpredictable and a swing of the fist was one way to find out if we were real or not.

He'd been at a rave party and someone gave him a hit of ecstasy -- MDMA or 3,4-Methylenedioxy-N-Methylamphetamine (one of those fifty dollar words we pretend to memorize in medical school). It's not uncommon for ecstasy to contain a mixture of chemicals and someone theorized his included ketamine, an anesthetic agent that may cause severe hallucinations. All we knew was, we had a psychotic kid with an uncertain prognosis on our hands.

His repetitive masturbation had become an expression of his mental state. Perseveration is the tendency to focus on a thought, word, or behavior, and repeat it over and over, almost like an obsession. In this case, most of the time he seemed scarcely conscious of what he was doing, though on one occasion, when I cracked his door open to verify he was okay, he came off his bed quickly, angrily demanding his privacy. I gladly gave it to him.

When his friends came to visit, he seemed almost normal and that was about the only time. I'd like to tell you his story had a happy ending, that he responded well to the medications, eventually was able to talk about his experience and express hope for the future. The truth is, after six weeks, he was transferred to a long-term care facility and I never heard from him again.

This is one of those situations you hear about but have to see to believe. Sixteen, popular, athletic -- he had a beautiful girlfriend -- his entire life was ahead of him. Whether the drug triggered an underlying schizophrenia or did irreparable brain damage, no one could say. He'd gotten better but he hadn't gotten well, and it wasn't clear he ever would. There should be a sign on the door of every psychiatrist, "Miracles are not performed here."

Even though we'd like them to be.

(Creative Common Image via Wikipedia)
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Thursday, June 10, 2010

Zen and the Art of Medical School

In your heart, you already know.~ Zen saying

Depending on the space we happen to be in, the heart's knowing can be a curse, a blessing, or none of the above. The hard part is getting our head into alignment with what we already sense, intuitively, to be true. This is precisely where I've been the past few days. Boards are looming on the 22nd and I've been trying to do what I usually do, namely, burn the candle at both ends without my fingers getting singed.

The trouble is, I don't think this strategy is working very well. I find myself distracted, my mind running off to medications, side effects, what ligament is attached where, while trying to say something meaningful about anything else. I suppose I could write about some of these things, but who besides a pharmacologist or medical student wants to hear about whether gentamicin binds to the 50s or 30s ribosomal subunit on a bacterium (it's the 30s, by the way)?

By my quick calculations, I can retrieve about 20 additional hours or so out of the next nine days for preparation if I absent myself from reporting here for duty each morning. The fact that I've delayed this decision so long is proof that the mind takes longer to wrap itself around necessity than does intuition.

So, if you will please forgive me, I'm going to be here, in my study, but not here, until the morning of the 23rd. I hate to do this, but it seems like the best thing, not only for the sake of my quality of writing, but in order to get to the next phase of my education, i.e. clinical rotations. If I had a Zen master, s/he would probably say, this is all part of learning to practice the art of medical school.

I hope you understand and will come
back on the 23rd -- I promise to make notes of topic ideas while studying and have some good things "on paper" then.

Thanks so much,


(Creative Commons image by Rickydavid via Flickr)

Wednesday, June 9, 2010


A compound wardrobe made of huanghuali rosewoo...

Yesterday, as I was musing about unfinished books as reminders of the person I used to be, I realized there's more to it than association. Some memories are tactile and merely the act of touching the pages of one's history can render it eerily present. And then, there are the books whose characters and contents are persistent, drawing me back year after year, stories I've lived through like cycles of reincarnation, revealing how unchanged I am, after all.

I was in seminary when I first read the line, "In a hole in the ground, lived a Hobbit," but even the best of Peter Jackson's CGI is unable to compete with my imagination. Film can't transport me to Helms Deep, or permit me to walk the Paths of the Dead, or wield my sword in battle side by side with Aragorn before the walls of Minis Tirith, but Tolkien does. Still.

It's the same with Aslan and the Pevensie children. We met in my second year of seminary, and to this day, I can't look into a wardrobe or dark closet without knocking on the rear wall, hoping it opens into Narnia. I haven't read them lately, but I don't have to. One glance at their spines and I'm riding the deck of the Dawn Treader and adventure lies on the horizon.

In my senior year of high school, I happened across The Fountainhead by Ayn Rand. Diligent non-conformist that I was, she found me to be fertile ground for her depiction of the individual against the collective. Although rotations will prevent my attending the high school reunion planned in August, if I were to go, my classmates would find I haven't mellowed a bit. The call to conform with neither reason nor rhyme rankles and raises my hackles faster than the Millenium Falcon can make the jump to light speed.

One evening in my third seminary year, I encountered an old man in the dining hall whom I'd never thought I'd meet. Quaker philosopher David Elton Trueblood, whose autographed copy of A Place to Stand sits on my desktop, has never ceased to inform my thinking about what it means to be a person of faith. Some don't need Reason to have faith, I do, even when my logic goes unsatisfied and Mystery shows me how shoddy are my efforts. Maybe this is a liability, I don't know, but Trueblood gave me permission to ask my questions, encouraging me to never stop, and I try to follow his advice.

Perhaps we accumulate books because of what they do as much as for the tales they tell, informing us who we are, reminding us who we once were, and prodding us to envision who we might become. Then again, maybe this is just another way of justifying the use of my Border's Rewards card. Between me and you, I doubt it, though. I really do.

(GNU Free Documentation image via Wikipedia)

Tuesday, June 8, 2010

Reminders of Who I Used to Be

Books, books...
I was raised on the notion that one should clean up their plate at dinner because there were people starving in China who were less fortunate. Naturally, being a kid, I thought, well, let's send it to them, because I'm ready for dessert! I internalized the same message about reading, i.e. don't start another book until you've finished the one you're on.

As a result,
I used to feel badly, almost a little guilty, about not reading right up to the very end. It was almost as though I'd made a deal with a book when I purchased it and was falling down on the job. And then, it occurred to me, some books are like some relationships, they aren't meant to last until the final chapter. It took me a long time to make peace with this, but I think I may have, at last.

Not that this is an earth-shaking revelation or anything, but it helps me reconcile myself to the fact that I've got several sitting on the shelf in various stages of completion. I'll run across them while dusting or looking for something else and remind myself to come back someday and "someday" never comes. Interests change, tastes alter, and what was intriguing once, is no longer.

It really is like dating. I've looked over annuals from graduate school, for example, and wondered, what did I ever see in her? Well, I must have seen something to make it worth a couple of movies, dinner, and an afternoon of miniature golf. But if I were in the same position today, I'd pass -- so would she, probably. At the time, however, it was a good idea and no regrets.

It's the same way with books. Some become old friends that you visit again and again, others are simply placeholders, there to keep the shelf from looking bare until you can bear to part with them. I tell myself they're good resources to hand along to patients or friends, but most of them never get beyond good intentions. So, on the shelf they sit, reminding me of the person I used to be.

Mm, put that way, it doesn't sound so bad at all.

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Monday, June 7, 2010

In Big Trouble

The traditional pop music song "Fascinati...

When I began dancing lessons, my goal was simple: develop enough skill to dance with the bride and a few of our friends at this weekend's upcoming wedding. If I got through without anyone needing emergency podiatry or me feeling like I should have stayed home and mailed a gift instead, the day would be a success. Dancing with the Stars or Saturday Night Fever could wait.

As it is, I've completed my first six weeks and decided to continue for a while. For one thing, doing so means I learned the foxtrot last Saturday, a real milestone. Not that it's all that difficult, but it's got style even if I have yet to develop grace, and it looks like late night slow jazz in a club in the Village with lovers whispering in darkened corners. Done well, even watching it leaves you breathless.

To be honest, what drew me to ballroom dancing was the image of leading someone across the floor like Fred Astaire with Ginger Rodgers, doing the foxtrot. I suppose I could be accused of being a romantic, but if you've seen the two of them in a classic film, you know what I mean. Besides, it strikes me as the kind of step a man can do that shows he's sufficiently secure in himself and his masculinity to at least try to be graceful.

And "try" is exactly where I'm at. My instructor is as fluid as mercury draining from a broken thermometer. Me? I'm still the Tin Man and Dorothy's taken the last train back to Kansas. But the beauty of the foxtrot is, it's forgiving. As long as you don't trip your partner and fall all over yourself in the process, you look pretty good. Not as good as Fred, but that's fine -- as long as none of my partners turn out to be Ginger. If that happens, I'm in big trouble.

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Sunday, June 6, 2010

Finding One's Flock

Canadian Geese taking off near Lakeview, Oregon
Once upon a time, there was a duck. He was your basic, no frills, no thrills and chills, flies south for the winter kind of duck. He lived, during the summer months, on a pond that was bounded on the north by a trail where people walked their dogs, jogged, or rode bicycles, and along its north side ran a happy little stream. Cottonwoods grew on both banks, and the duck thought they lent a quaint pastoral quality to the scene, rather like the opening bars of Beethoven's Sixth. Besides, he liked the shade.

The dogs he didn't mind, despite their proficiency at barking when they saw him. The Labradors were the most entertaining, he thought, when they leaped into the pond trying to catch him by surprise. He'd simply fly off and circle overhead, imagining himself a bomber pilot, taking aim with a well-placed plop! Then he'd land and resume paddling around as if nothing unusual had happened. It was a good life and he had few complaints that he considered worth mentioning.

There's one, however, I think we should mention, even if he wouldn't. You see, unlike most ducks, he had a secret life. I mean, how many Mallards or Mandarins have you met who are familiar with Beethoven? Not many, I'll warrant. But this fellow was and he also enjoyed Handel and Bach. I never got around to asking him where he obtained his classical education and he was so modest, he never told me himself. What he did tell me was how odd it made him feel and how solitary his life was, as a result.

Apparently, conversation at the pond, when other flock members dropped down for a chat, revolved around the weather or who was nesting with whom. Pretty much the same kinds of things people discuss at lunch. He would have liked to introduce a topic with more depth but the closest he could come was how far below the surface the best fish were to be found. It was frustrating at best, and naturally, he couldn't be seen fraternizing with a human -- tales of Elmer Fudd and Daffy are the stuff of legend -- so our conversations had to occur on the sly.

This story might have had a melancholy ending except for the fact that one day a couple of Canadian Geese happened by. We were so engrossed in discussion we didn't notice them until they landed practically on top of us, sending water flying in nearly every direction. "That was Homeric, eh?" cried one, "I'd like to see Achilles do it better, eh?"

The duck and I looked at one another in amazement. "Sounds like your kind of people," I said. He nodded and swam over to introduce himself, said something about the Odyssey, and the conversation literally took flight. It was fascinating to watch their friendship develop over the remainder of the summer but I felt apprehensive with the approach of winter. Turns out, I had no reason. Since Canadian Geese are year-round Colorado residents, they adopted my friend. He may look like a duck on the outside, they said, but inside, he's all goose. Truer words have rarely been spoken.

It reminds me of medical school, and how, sometimes, you discover your true flock isn't the one you were born into, but the one you find when you're least expecting it.
(Image of unknown license via Wikipedia)

Saturday, June 5, 2010

A Conversation in Heaven

Fog in the Park

Reflecting on yesterday's post and the presence of an allusion to my grandfather's selection of pipe tobacco got me wondering if there wasn't a connection to be followed up on. So, today's is an imaginary conversation in heaven that, hopefully does just that. "Doc" is the nickname by which my grandfather was known to family and friends.

"Hey, Doc," said the old man,"so whatja think?"

"I thought Velvet pipe tobacco was a nice touch, it got him thinking. Say, you didn't happen to bring any back, by any chance?"

"Naw, you know The Rule: You can't take it with you."

"Yeah, but I thought someone in your position might wrangle an exception. I assumed angels had influence."

"I would've if I could've, how's that?" the old man replied, stretching, shedding his appearance like a pair of one-piece coveralls. "Mmph, these transformations are wicked, pardon the pun. I don't know how humans do it, especially as long-lived as your family is, spending all your time in a body like this."

"It has its ups and downs," Doc said, musing. "You get sick now and then, get arthritis, maybe break something. But there's compensations and we wouldn't trade them for anything. Holding your first born -- my wife could cook up a storm, by the way -- and there's, um, well, there's always...romance," he said, his mouth upturning impishly at the memory.

"I know, I know, romance, then pregnancy, then bills to pay, gray hair, putting the kids through school, and voila! you're here."

"True, there's all that, but you met my grandson and his dog. I don't think we did half-bad," Doc argued in defense.

"No, you didn't. He made the right choice and got home in one piece exactly like you said he would, and like you did, by the way, that morning on the mountain, chasing cows through the fog. For a minute, you had me concerned."

"Was that you? I've wondered about that. Yeah, it was hard; I'd made a lot of bad decisions over the years. And then, I don't know what made me think of it, but it occurred to me I might have a grandson at some point, and I'd want him to make the right choice, too. That's what made the difference. I did it for him."

"It often does and most people do," responded the angel, cryptically.

"I guess so. Say, you sure you didn't bring any Velvet back with you?"

"I'm sure."

(Creative Commons image by laurenz via Flickr)

Friday, June 4, 2010

Lost: A Metaphor

One evening, rather late, I'd been out walking the dog, and my mind began to wander, as it often does on those occasions. When it gets dark in Maine, it gets d-a-r-k, and particularly so because of the trees. Tall white pines as straight as power poles, their needled tops intertwined and their lower trunks scraped clean, growing so close together they resembled fans in a mosh pit, formed a ceiling between me and the early stars.

How we got off our usual path, I don't know, but we did and it wasn't long before I began feeling slightly nervous. Nocturnal creatures abound up here and while "lions, tigers, and bears" weren't likely, coyotes were. Possums, woodchucks, and foxes are shy and standoffish, but coyotes run in packs and I wasn't eager to play Sharks against the Jets, especially since the rest of our gang was nowhere to be seen and Leonard Bernstein wasn't around to provide background music (West Side Story).

By the luminous dial on my new Black Dog watch I could tell we'd been 20 minutes and close to a mile into the woods when we came upon something I would only have expected from Stephen King. The trees spread apart, forming a glen, and on either side was a tall gateway with a wooden crosspiece bearing a sign beneath it. The one on the left read "Too Late" and the one on the right, "Never Too Late." Before I could say anything about the glass being half-full or empty, my dog and I both startled at the same time, noticing a man sitting on a fallen log off to the side, smoking a pipe. My dog growled, uncharacteristically.

"Easy fella, didn't mean ta scare ya," he said, in a typical Southern Maine accent. "You're new round heah, but I seen you two walkin'. Figgah'd you'd get heah sometime."

"We live somewhere nearby," I said, looking around and waving my hand in the direction I hoped was home.

"Mm. Lost. Happens a lot. Folks only think they know wheah theah goin'." He stood up and took a few steps closer, the smoke from his pipe trailing behind, he was like a locomotive getting up steam. Velvet tobacco, I thought, sniffing, the same as my grandfather. "Well, you got a choice," he said, using his pipe stem as a pointer, "one or t'other, everybody does."

Wondering if I'd inadvertently stumbled onto a scene from Our Town, I said, "Wait a minute, I'm just trying to get home."

"Home is where the haaht is and you're heah. You want ta get somewheah else? You gotta choose. I'll tell ya right now, most folks go left. Oh, they look right and some even poke their heads through -- don't know what they think they'll see -- but then pull back and go left. Guess theah too used ta things the way they ah. It's hahd to go against the grain. Anyhow, you gotta choose. May as well get on with it."

I glanced down at my dog, who glanced up at me and raised one eyebrow in response, imitating, as I like to imagine, Mr. Spock. The man relit his pipe and added, "Yoah some kind of preachah, ain'tcha? (How could he know?) Oh, I know lottsa things. You'll like this, then. Hell's motto is 'Too Late.' Yup, it is. You prob'ly knew that already, bein' a preachah and all."

"Hell's motto, eh? That simplifies everything," I said, and my dog and I headed right.

"You'd think moah folks would realize that," he said to himself, though loudly enough for me to hear.

We'd barely crossed the threshold when it became obvious we'd walked out of the woods into my hayfield, the lights of the house shining on the hill ahead of us. We'd been on my own property, all the time. I looked back, expecting to see an old man, clouded in smoke, framed by the gate we'd just entered, but there was nothing. Only the trees and a tiny glen.

Later that night, with my dog asleep by the fire and the cat curled up next to him, I wondered aloud, what would have lain in wait, had we gone to the left. "A lot of unhappiness and regret, most likely," I said, answering my own question. At that, my dog stirred, looked up, wagged his tail, and I was glad we never found out for ourselves. Some things really are best left behind in this life and the pathway marked Too Late is one of them.

(Photo copyright 2010 by the author -- double click on it to enlarge)

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Thursday, June 3, 2010

Gross Anatomy in Sneakers

SAN DIEGO, Calif. (May 28, 2009) Sailors, Mari...

Psst. Don't tell my professor, but one of the liabilities of studying anatomy is, someday you might actually begin thinking about it. Not only in the sense, for example, that a patient has an occluded left anterior descending cardiac artery (LAD), but that you have the same vascular tubing running along your heart -- it's right there, lying beneath your right hand when you say the Pledge of Allegiance.

Go ahead, try it, put your hand over your heart and then drop it a teensy bit lower, around the bottom of your pocket. Now you've got it. We can't really feel the LAD because there's skin, muscle, and bone between it and us, but you get the idea. When your neighbor tells you he's going to have coronary angioplasty, narrowing or occlusion of arteries like the LAD are the reason.

Normally, most of us don't think about all of this, we just get out of bed, get dressed, and get on with life. In the anatomy lab, we examine, dissect, and probe these structures, but we're so engrossed in learning and trying to pass that we don't let the impact sink in too deeply. Then one day, when we least expect it, we're contemplating the meaning of the universe and it hits home: I've got an LAD, too, just like the poor guy in room 405, only his is clogged chock full of cholesterol, and mine's clean as a whistle. I hope.

It might come about while working in the ER and a crash victim comes in. While you're taking their history, you realize you have similar interests, and she's got a scar on the right side below her navel from an appendectomy just like yours. And it hits home again, this could have been me. It's almost enough to make a person hole up in their room with the blankets pulled over their head.

Of course, we don't do that, because denial conveniently helps us keep the harshness of reality at arm's length most of the time. Accidents and occluded arteries happen to other people, not us. It's how we survive, denying the fragility of life and our bodies, to get by from day to day. But every now and then, we become aware that even the study and practice of medicine doesn't render us immune to being human. We're all as vulnerable as anyone else and that's the way it is, with no free passes out of jail, and nobody handing us $200.00 when we pass Go.

Don't worry -- I'm not writing this because I've been diagnosed with some bizarre sounding thing related to my LAD or anything else, for that matter. I was simply thinking about the circulation of the heart while doing board preparation and one thing led to another. Visualizing where the arteries went for the sake of the exam reminded me of my own, and the next thing I knew, gross anatomy in sneakers had crept up behind me and said, "Boo!"

(Public Domain image via Wikipedia)

Wednesday, June 2, 2010

Driving Miss History

1968 Ford Torino Squire I photographed in Beve...

I've got a buddy -- two weeks ago I'd have called him a fellow medical student, but since he's newly graduated, he's "Doctor" now -- who drives a station wagon. I'm not sure most people under 30 even know what a station wagon is, much less have ever ridden in one. Oh, true, they may have been a passenger in a Mazda 6 or Jaguar T Type, but that's the point: no one calls them "station wagons" anymore.

I can't say I learned to drive in one, but we had a Dodge with a push-button transmission once, and I did my share of pretending. I must have been close to 13 because I remember getting "car crazy" around the same time the hormones started kicking in. It was hard to imagine racing while pushing buttons -- little did I know the same technology would characterize Formula One in 2010 -- but it was all we had, so I made do.

Later on, the Dodge was replaced briefly by a mid-sized Ford Torino Squire wagon with imitation wood siding. We hadn't had it long when the transmission died in a snow storm late one evening. It was a case of man and machine against nature, and as you might expect, nature won. I recall seeing my father in the driver's seat, staring into the rapidly falling and piling snow as if to say, "We'll meet again, you and I." He didn't get out, draw his six gun and shoot the Torino as a movie cowboy might when his horse stepped in a prairie dog hole and broke its leg, but I'm sure he was sorely tempted.

That night was memorable, not only for my father's self-control, but for the fact that it heralded the end of his romance with Ford. A few days later, he purchased a Pontiac Grand Safari wagon, and remained faithfully wedded to General Motors the rest of his life. Admittedly, he had a brief and torrid love affair with a 1966 Ford Mustang, but we don't talk about that in polite company.

So, back to my friend's wagon. In a few more years, it will be a classic and if it holds together long enough, maybe a collector's piece. As it stands now, you wouldn't want to run into it with a Honda, unless you're intent on totaling your car while his rolls away without a scratch. It actually has a steel hood stout enough for the two of us to sit on without denting. Yup, he's driving Miss History, perhaps more mine than his, but that's okay; he loves her and that's all that counts.

(GNU Free Documentation image via Wikipedia)

Tuesday, June 1, 2010

Memories of June

baseball glove
I've always felt June got shorted. April has April Fool's Day, May has Mayday -- along with Cinco de Mayo -- and then here comes poor June with nothing. It's like being a bridesmaid at a wedding with one of the groomsmen out sick. As the other couples are walking back down the aisle, she's bringing up the rear, smiling bravely -- and wishing she was somewhere else.

When I was a kid, of course, the first of June signaled the end, or close to, of school. Any time spent in class after that date was torture, even worse than what I'd experienced the ninth months previously. Visions of prison camp danced in my head as I imagined my teacher morphing into a whip-cracking taskmaster to rival Severus Snape. Well, maybe it wasn't quite that bad, but it sure seemed like it.

Fortunately, the weeks of freedom that followed were filled with baseball, riding horses, and exploring the woods and fields near our home. Those days come to mind while planning the next three weeks of board preparation. But it's different now, since I'm the one insisting on time before the computer, hoping the pile of review books almost brushing the ceiling doesn't come crashing down on my head.

It also helps not having my friends knocking at the door, wondering if I've gotten a new outfielder's mitt or a list of chores to perform that my father left for me, considerately, before driving to work. Knowing all my work will permit me to begin rotations in August is payment enough, but there's still the memory of summer days with cool mornings and warm nights, that come trickling into consciousness, reminding me that June is here, at last.

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