Sunday, October 30, 2011

Things Dads Do

For a long instant, it felt like Thanksgiving this morning, stepping into a warm living room from the chilly garage where I keep my ready access firewood. With four inches -- nearer six or eight if it was powder -- of firmly packed, heavy, wet snow covering the hayfield, it looks like Thanksgiving. It also looks like a few of the Halloweens of my youth when the end of October mistook itself for the beginning of winter. With a fire softly burning (thanks, JD, for the image) in my the way, we didn't have a fireplace when I was growing up, have I told you?

Our house was small -- three bedrooms, one bath, kitchen/dining and living room, all heated electrically. The closest we came to a fireplace was a small wood-burning stove in our unattached garage that my father used as his saddle shop for several years. Hardly a stove, it was a twenty-five gallon oil drum turned onto its side with a door cut into one end and four welded feet. How he worked out there, winter after winter, is a testimony to a father's love and determination.

I split firewood for him. I remember grousing about it at first, as any kid might, torn from afternoon cartoons to trudge out to the woodpile near the barn. I'm supposed to play, not work, I thought. He overlooked my complaints and taught me how to set up a block of wood, take aim for the middle, and swing without missing. It wasn't long before I began enjoying standing there in the snow with my axe and carrying armloads of split logs into the shop, losing myself in a "living-on-the-ranch" reverie. Writing about all this, I recall a day when I grew up a bit, realizing how my "work" kept him going. I must have been around nine or ten, but I began appreciating my father more than I had before.

Shared tasks, working together, those were his values and he passed them along to me. He was raised in a time and place where everyone had a task and everyone contributed to the family's welfare. He and his siblings had chores, a word one rarely hears anymore and tends to be associated with black and white reruns of old western television shows like The Rifleman on AMC. When used now, it's often in the pejorative sense, life is a chore. And some of his were all of that, especially when he was too young to ride after the cows and had to content himself with milking them, instead. Reality fails to imitate art every now and then.

He wasn't heartless about chores, though, and perhaps that comes from his own experience. One afternoon after school, he'd been too busy to cut wood into sections as he usually did, leaving them for me to split. So I started in with my axe, intent on doing both the man's job and the boy's. He came out a short while later and in a gentle tone he reserved for just such moments, told me I could stop, he had enough wood for now. I was hesitant -- the wood box was nearly empty as anyone could see -- but he assured me he was fine and to go on into the house and get warm, The things dads do.

A person has to wonder where the desires of the heart come from. I still love fireplaces and going out into the forest to cut wood. The axe of my youth has been replaced with a splitting maul, five pounds of steel at the end of forty inches of Ash. There is a sectioned tree trunk, well over a hundred pounds itself, sitting in the garage, the legacy of the doctor who lived here before me, that is our common chopping block. The open rafters are high enough for a full-armed swing.

Sheltered from the weather, it's not the barnyard of my childhood. Nor is my work that of my father. But the appreciation for a warm fire on a cold morning we share, as well as the effort to bring it to life. From whence comes the desires of the heart? I can't always say. What I know with any certainty is, I can't plunge my maul into a block of wood without thinking of all those afternoons, splitting wood in the snow, and my father who taught me how.

(Creative Commons image by Gadget_Guru via Fkickr; "a fire softly burning," Back Home Again, words and music by John Denver, copyright 1974)

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Saturday, October 29, 2011

First Assist

SurgeryMore years ago than I like to advertise, I was flat on my back in a hospital bed, awaiting surgery for kidney stones. It all began on a typical July 4th weekend in northwestern Colorado, visiting family and fishing in the high country. A delightful lunch of cutthroat trout cooked over an open fire was followed by nausea, vomiting, and abdominal discomfort that puts the P in pain. The local ER doc diagnosed a renal stone and I began seeing a urologist in Denver the next week.

As we say in medicine, my initial treatment was conservative, i.e. reduce calcium intake and drink water or cranberry juice like it's going out of style. At that time the theory was, my kidneys were less adept at eliminating excess calcium, so by flushing them with clear fluids, we'd rinse them of the offending chemical. It was a good theory; the problem was, it didn't entirely work, resulting in my first exposure to surgery coming from the patient's side of the operating table.

I spent this past week, and will spend the next five weeks, on the surgeon's side and believe me, that's a whole lot more fun. Not that I minded being a patient, but the lessons I learned have stuck with me. For instance, there's nothing like being at the mercy of the healthcare system to teach future doctors to pay attention when their patients speak. It's one thing to get report of 522b's requests for morphine and quite another to have been 522b, in severe pain, and have to wait -- in pain -- for the hours to tick away like days before the next round of medications arrives. Thanks to the gravel pit that collected in my left kidney, I know what this is like.

What makes the surgeon's side of the table more enjoyable -- apart from the absence of pain -- even for this incipient psychiatrist, is the fact that you're delving into live anatomy. For all the times you may have laid scalpel to preserved, leathery cadaver flesh, when you insert your fingers into the warm open incision of a living person, you've got to experience a mix of awe and fear. Fear that you'll do something harmful and awe because you're in a position to do so, probing where no one has gone before. It's enough to make the crew of the Enterprise envious.

My week, as do most, began with Monday -- orientation, a meet and greet with the staff, butterflies in the stomch. The next four days were spent in the OR from near dawn to mid-afternoon, when the surgeons head off to do office work and I'm left on my own. This
rotation is largely self-directed and I have the freedom to pick and choose the procedures I find most interesting to scrub-in on. Since I'm working in a community hospital, I won't see cardiac or severe trauma cases -- we don't have the ICU facilities for major surgeries like those -- but I'll definitely see the kinds of things most of my future patients will experience and that's what matters. Naturally, I'll scrub-in for all those performed by my primary instructors, but I can also work with any other surgeon who's willing to have a student along for the ride.

It was the latter that led to another first this week, an opportunity to act as First Assist, the individual who stands opposite the surgeon, ready to offer whatever assistance the surgeon requires at the moment. Ordinarily, First Assist is a trained nurse, PA, or another physician. Under the right circumstances, however, it may also be a student. Yesterday the tumblers clicked into place and I was in the right place at the right time.

Now, before this begins to sound "important," in point of fact, I didn't actually participate in the sense I cut this (aside from sutures) or pulled on that (aside from retractors). Still, having an extra set of hands can be helpful and mine were eager to be put to good use. From a student's perspective, you're assisting, even in small ways, and that's always better than observing or merely standing by, all scrubbed up with nowhere to go and nothing to do when you get there.

And the word gets around. You've done the job once, you were attentive and diligent,
you didn't screw up, the doctor seemed to enjoy your company; he'll tell other docs and you'll get to do it again. The more often you do, the better you'll get, and sooner or later, someone may hand you a scalpel, which to your inexperience feels like a Bowie Knife, and say, "You make the first cut."

Are my hands ever eager.

(Creative Commons image by Army Medicine via Flickr)

Saturday, October 15, 2011


Babe and farmer hoggettWhen the dogs and I stepped out of the house this morning, the lane was littered with oak, elm, and magnolia leaves so thick our feet (my feet, their paws) barely touched the blacktop as we walked along. It rained last night, not a gentle, soaking, spring-like shower I imagine makes the trees lift their limbs and whisper to one another, "Psst, pass the soap, will you?" This one was intermittently wind-blown and down-pouring, scattering leaves and drenching the countryside. It was the kind of rain that rinses the air clean as a whistle and whets sunlight sharp as a tack.

As we walked up the road, morning business on our minds, something unusual caught my eye. A single leaf, a tiny piece of oaken gold, hung spinning in mid-air, its stem caught in a single strand of spider web, like an arboreal ballet dancer dancing as though her moment had come and never would again. I'm reminded of the line by Mark Twain, Sing like no one's listening, love like you've never been hurt, dance like nobody's watching, and live like it's heaven on earth? That's what she was doing, drifting and swaying to music beyond my hearing. I was mesmerized.

Some people never notice the things that render life more than a matter of getting by, those side-long, fleeting instants when eternity opens a window, reaches through, and taps us on the shoulder. Sort of like what happens in the film, Babe (1995) with James Cromwell as
Farmer Hoggett, a man who notices. Hoggett lives on a sheep farm in Queensland, Australia, and to his family, he seems a bit odd now and then. They're solid, ordinary people who are nevertheless, completely unaware that eternity has not only opened a window, it's climbed through the frame, unpacked its bags, and taken over the guest room.

Hogget knows something is happening. He can't explain it, neither does he bother to try; some things you try to explain and their significance gets lost in the details. He simply lets it all in and follows its lead. Presented with possibilities others would dismiss, he can't help but take them seriously,

For instance, when he notices how Pig interacts with his sheep, he allows the little guy a chance to prove himself. Hoggett sees what no one else can or will, and while he's a man of few words, his actions are as pregnant as a woman at nine months who;s about to pop. Only he doesn't just notice things, he responds to them, opening a creative space in which they can unfold at their own pace. We're often in such a hurry to find out things will turn out, perhaps because we're in doubt they will, that we forget about everything that comes before. Hoggett's efforts are ridiculed, of course, even by his family. But then comes the final scene, when the crowd that jeered goes crazy, cheering its heart out over the little pig that could.

Hoggett knew what Pig was capable of because he'd witnessed it. He noticed something unusual and instead of blowing it off as nonsense, he did what most of us are too afraid or too embarrassed to do, he gave it credence. He did the hard thing and in the end, he wasn't disappointed. It really all begins with noticing.

(Creative Commons image by Lord Mariser via Flickr)

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Friday, October 7, 2011

Missing Megan Fox

Transformers: Revenge of the Fallen
I really like Megan Fox, but not necessarily for the reasons you might think, me being a guy and all. Sure, she's drop-dead gorgeous -- I'd have to be blind as a bat not to have noticed and trust me, I've noticed. But what I like about her so much is her role in the first two Transformer films. No, I'm not talking about the cutoff jean shorts she wears in both, though I noticed them as well. I mean her character.

Megan (if she's reading this, I hope she doesn't mind the familiarity) plays Mikaela Banes, a pretty young woman with a past. Her father has a prison record for grand theft auto and she, a juvenile record for having been his presumed accomplice. She has another liability, however, and that's her beauty and sex appeal. Like far too many women, she has a history of being regarded as a trophy.

In the first film, her boyfriend is a muscular, good-looking, football player who treats her like a possession once too often. She knows there's something wrong with the guys she's chosen to date, she doesn't like the pattern, and she has sufficient inner strength to do something about it. As she's walking home, along comes the film's hero, Sam Witwicky. Sam is everything the other guys could never be: overtly insecure, honest, and down deep, utterly courageous.

In the first installment of the trilogy, Mikaela is not only a match for Sam, in some ways she is even more heroic. For instance, when they're attacked by a mini-decepticon, she grabs a power saw and goes to work, rescuing him. During the final battle against Megatron, she is determined to save Bumble Bee by hooking him up to a tow truck and then drives it backwards down a wreckage-strewn street while he shoots at the bad guys. I love that scene.

In Revenge of the Fallen, her character is a little more traditional and her biggest challenge seems to involve convincing Sam to tell her that he loves her. Sam, how crazy do you have to be to have someone like her around and dither about saying, "I love you?" Get a clue, buddy. Anyway, that bothered me, the fact that she wasn't permitted to be the totally gutsy chick she was in Transformers. Her character wasn't just beautiful, she was admirable.

Now we come to Dark of the Moon and there's no Megan Fox. Instead, we've got a blond babe whom Sam has decided is the love of his life. She flirts with other guys and then minimizes her behavior, she's essentially focused on the accumulation of expensive toys, and perhaps, worst of all, she has absolutely no idea what makes Sam tick. You tell me what's wrong with this picture.

If we wanted to get psychological, we'd have to ask why Sam hooked up with her in the first place. According to the story line, he and Mikaela had a fight, broke up, and rather than do what any man with a lick of sense would do, i.e. turn himself inside out to get Mikaela back, he lets her go. Sam clearly has far too much pride for his own good. It's what kept him from declaring his feelings in Revenge of the Fallen and it comes back to haunt him in Dark of the Moon. We could be Freudian and say the new girl is more like his mother, but we really don't have enough character development to go that route. We do know, however, that Mikaela and his mother are two very different kinds of women and that could explain a lot.

For whatever reasons the producers decided Megan's character wasn't meant to be a part of the last film, I miss her. I liked Mikaela's resourcefulness and willingness to take a risk. Her response to Sam's question, "Fifty years from now, when you're looking back on your life, don't you want to be able to say you had the guts to get into that car?" is one with which I, as an older medical student, can well identify. I also liked the fact that she wasn't squeaky clean. She had a past she was ashamed of but she refused to let that prevent her from something better. Her wounds made her human and more interesting. Best of all, I think, she didn't allow herself to be paralyzed by fear. She could be counted on in the clinches and was capable enough to be a participant in the action rather than a hand-wringing damsel-in-distress. Definitely the right kind of gal and why I'm missing Megan Fox.

(Image of Transformers: Revenge of the Fallen via

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Thursday, October 6, 2011

Welcome to Night Float

Night Cityscape 2

It's enough to give a night person an identity crisis. Working night float, that is. Oh, and while we're on the subject, why do they call it night "float," anyway? Does staying up past the witching hour somehow render a person more buoyant? If so, I sure hope it doesn't mean extra mass, too, because, like Scott Calvin (The Santa Clause, 1994), I've tried to be diligent about watching my points lately.

Truthfully, I think "night float" probably does refer to the idea of rising up from the day shift, like a bubble, and floating along its surface from 6 PM to 6 AM. If there are any readers who know the derivation of the phrase, please, feel free to leave a comment. Inquiring minds would love to know -- especially mine.

Anyway, the reason I say it's enough to throw a night person into an identity crisis is, there's nothing like working from sundown to sunup to make you appreciate daylight. When I was younger, I would wake up just as my parents were paging Mr. Sandman. It made trying to get me into bed an interesting proposition sometimes, I'll tell you. But working overnight isn't quite the adventure staying up late once seemed to be.

True, from the perspective of seeing patients in the ER, it's perfect. For reasons I've never quite fathomed, most sickness hits after dinner. Ever notice that? You're fine until 3 AM and then you're hugging the diagonal dimension diver. Partly, we hope whatever has us in its grasp will let go if we just pretend we're fine. Of course, it doesn't, and in days of old, when doctors still made house calls, dad got on the phone while mom mopped our foreheads with a cool washcloth.

Maybe that's the image many of us retain, only now, we have to go to the doctor rather than have her or him come to us. I've heard of a few died-in-the-wool family docs who still get the Jeep out of the garage when it's fifteen below and the snow is piling up like paperwork at tax time, but they're the exception, not the rule. More commonly, folks show up at the emergency room where a medical student like me is waiting, making them wonder if coming to the hospital was such a good idea, after all.

Bushy-tailed and bleary-eyed, I'll introduce myself and explain I'm the first in what will surely feel like the 300 Spartans before we've finished asking the same questions over and over, trying to figure out what the patient already knows: they're sick, otherwise they'd be home in bed, where I'd be too, if I had any sense. We talk, I take their history, do an exam, and then the resident comes along and together we decide what needs to be done. It's a learning experience and one I'm grateful for, but I'm glad last night was my last for a while, because after night float comes morning report.

Morning report is where you realize what sleep deprivation really means. That's when your attending physician asks you the details of the case you admitted the previous evening, only now your brain feels like a bowl of cold oatmeal that has the consistency of cement. The data is there, you're certain of it, because you spent two hours writing up the case. Except what you thought expressed medical brilliance hours before suddenly looks like, "Oh, God, how could I have said that?!" You glance over at your resident who's smiling encouragingly, remembering their own third year and what it's like, being in the hot seat.
Eternity eventually passes, rounds are finished, your attending tells you "good job," and you're left, wondering whether you've got the energy to get home or should you simply fall asleep in your chair. It feels so good, so soft, so nurturing, it would be so easy to just...drift...away...and then your pager goes off.

Welcome to night float.

(Creative Commons image "Night Cityscape 2" by Kent C via Flickr)

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