Saturday, November 26, 2011

Not Exactly "Friends"


When and where I grew up, a person rarely heard the sound of gunfire. In fact, I can only recall a single occasion when I heard it within the county limits. My father was boarding a horse for a friend of his who was an avid hunter. One afternoon, concerned his new horse might be gun-shy, he and my father led the horse into our pasture and the friend fired his pistol into the ground. His horse just stood there, apparently unimpressed, waiting to be released so he could return to grazing. Why shoot into the ground? Well, despite the fact that terrorists are always firing automatic weapons into the air on film, in reality that's not a wise practice because what goes up will inevitably come down, including bullets.

So, that was the only time. Hunters eager for deer or elk had to go up into the mountains to find them and those who sought ducks or pheasant, to eastern Colorado. The fact is, there were laws prohibiting the discharge of firearms near populated areas which, if you think about it, is a wise practice. Every year there are stories in the news about someone mistaking a partner, cow, or dog for deer or moose. How you get a moose from a dog, beats me, but maybe at distance Snoopy looks that big. Anyway, s/he hears a rustling of leaves, the snap of a twig, they turn and squinting through the trees, spy a shadowy figure. The thrill of pursuit coupled with the release of adrenaline takes over and you can guess the rest.

When I relocated from Maine's seacoast, I was informed, "Oh, now and then, you might hear a gunshot or two," since this is fairly open country and Maine law permits shooting on private land. To put it another way, were I so inclined (which I'm not), I could sit comfortably in my lawn chair on the front patio with my father's western-style .30 caliber carbine across my lap and wait for the deer who gobbles up my apples to wander into the crosshairs. Either that, or I could purchase a shotgun on the internet for next to nothing and sneak up on the flock of turkeys that also feed freely on my apples to provide next year's Holiday meals. It would all be perfectly legal and conveniently culturally-sanctioned.

Except for that darned, interfering Super-Ego (Freud's term for moral and personal conscience) of mine. I don't generally shoot at friends unless they really, really, really, piss me off and then I prefer to throw pies at them. I'm joking (even about the pies). Truly, I am. Please, pretty please with maple sugar on it, don't call the FBI ("Honest, Agents Sculley and Mulder, it was only a literary device, you know that from the lines the two of you have to memorize, right?"). Well, while we're not exactly what you'd call "friends" -- I haven't invited him in for coffee or tea with late season apples lately -- I do like seeing Bambi wander through the hayfield, munching freely at will. I also like the turkeys, porcupine, and the other wild critters who seem to think this is their farm and they permit my presence, not the other way around. Maybe I'm softheaded in a hardhearted world, but it seems only reasonable to live in consideration of those who were here long before me and, no doubt, will continue to be once I'm gone.

Now, fair is fair and I don't want anyone to think I have something against my neighbors or anyone else who hunts, because it's not like that at all. True,
I'm still not fully accustomed to being awakened on weekend mornings by what I'm convinced is an M-16 going off within walking distance of my house. If it was 1772, when this community was founded, I'd take my trusty long rifle down from over the fireplace and like any other responsible farmer, parson, or whomever with a family, head for the woods imitating Hawkeye from Last of the Mohicans. But this is 2011 and, like I say, I'd rather not shoot at friends or a reasonable facsimile thereof. As things stand, I'll wear orange as a precaution while cutting firewood or walking the dogs, that's not a problem. It's nearing January, it will all be over soon.


(Creative Commons image and Bambi and Thumper by Jaded Jeremy via Flikr)

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Thursday, November 24, 2011

Gratitude


Thomas Aquinas stained glass window.
St. Francis of Assisi knew gratitude was good for us long before this month's Harvard Mental Health Letter added its two cents, but isn't that the way it usually goes? Evidence follows intuition. Well, according to my friends at Harvard, gratitude helps make us resilient. In fact, it's one of many things that have that effect. For instance, working at something you love rather than working less, having a sense of life purpose, giving for no other reason than because you can, forming and maintaining meaningful relationships, and possessing the confidence to steer your own course, also render a person more resilient in the face of whatever life throws at us along the way.

Resilience doesn't mean resistant, it means durable. Resistance can carry the connotation of immunity to injury. Resilience and durability are fluid concepts that describe those who endure what Hamlet called, "the slings and arrows of outrageous fortune," and come through scathed and scarred, perhaps, but not embittered. Resistant, to me, is a wall; resilient is a membrane, tough and tender, alive, open to experience.

Thinking about gratitude and the resilience it engenders, on this Thanksgiving eve, I'm grateful for a young woman who became the first live human in whose body I've inserted a scalpel to make an incision. She was unconscious at the time, "thanks" to the wonders of anesthesia, but I was sufficiently aware for both of us and so grateful for the privilege she'd granted, I was close to tears when the final sutures were in place. It felt as though I was incising something from my own life (a topic for another post) as much as something from hers.

I feel grateful for my entering medical school class, a group of people, all of them younger than me by months to years, in whose company and because of whose support, I've somehow managed to come this far. They play hard, work harder, each having sojourned in at least one of Dante's Twelve Circles of Hell, and survived with hope and heart intact. It's a privilege to be numbered among them.

I'm grateful for the snow that began falling overnight, the plow that woke me at 4.06 AM and the hunger that followed in its wake, dragging me from the warmth of bed to face the chill of my upstairs room. I'm glad I raked the leaves crowding close to the kitchen door and straying carelessly onto the driveway last night, so that shoveling snow this morning was easier. It was dark in central Maine, dark and cold, and the drive to my hospital slickly hazardous. I'm grateful my CRV takes little note of the weather, embracing ice and snow as a challenge, instead of a threat.

I'm even grateful for the fuse that blew in the kitchen this morning. Power outages in the forecast, I made coffee last night and put it in the fridge -- cold coffee being better than none. Warming it in the microwave was too much too early, it seems, so I had to take flashlight in hand and brave the depths of the cellar I've considered the ghastly realm of goblins, spooks, and creatures unspeakable. It was nothing of the sort, but gazing into the black basement of our creakily ancient temporary housing, my imagination ran rampant. Yoo hoo, Stephen King, are you down there?

Some things only a fool or a madman would be grateful for, but it's the trivial we most often overlook. Those insignificant moments of inconvenience over a blown fuse teach us how to draw upon gratitude when we need it the most. Those moments that remind us that faith, hope, and love can be found anytime, anywhere, and not merely the one day of the year we remember to give thanks. Whoever said, it's the little things that count, wasn't kidding.

Happy Thanksgiving!


(Creative Commons image of St. Francis of Assisi via Wikipedia)

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Sunday, November 20, 2011

Paying Your Dues or to Paraphrase Charlie Brown...


"Doesn't anyone know what surgery is all about?"

I've been wrestling with this question for the past four weeks and it hasn't been an easy match. I thought I had it pinned a couple of times and then it squirmed out from under me. Think about those occasions when you've watched Olympic wrestling and you'll get an idea what I mean. Both shoulders have to touch the floor at the same time for a winner to be called and close isn't close enough.

For my friends who are surgeons-in-residency or our preceptors, the answer is probably straightforward, surgery is about cutting. Suggesting there is a deeper philosophical significance for what they do is likely to trigger a smile, a good natured nudge in the ribs, and, "There Beggar goes again." Sorry, guys (a non-gender specific term for me, inclusive of gals, guys, and a dog or two thrown in for good measure). I can't help it. Finding meaning is what I do.

That said, I'm really not referring to surgery as such, but to basic surgical training, i.e. third-year surgical rotations. The former is way out of my league, but regarding the latter, to borrow from Country singer/songwriter Garth Brooks, I'll "choose to chance the rapids and dare to dance the tide." But as anyone knows who's rafted the Colorado or any other big river, you've got to have a guide who knows the water, and on this chilly November morning, it's my father's turn to take the tiller.

What does a saddlemaker have to do with surgery? Aside from the fact that he was well-acquainted with sharp knives and slicing through flesh? He knew what it was like to be an apprentice. You see, at the end of World War II, when he was discharged from the Army, the way someone pursued a career in saddle making was by apprenticing themselves to masters of the art. These were men, predominantly, who began honing their craft well before my father was born. They started out precisely as he was expected to, by sweeping the shop floor, watching and listening, doing a lot of what we call in medicine, "scut work," and waiting his turn.

It was frustrating, he told me years later, because he wanted to learn and surely, that was best done by doing. Being told he wasn't ready to "do," that he'd be told when he was, tried every ounce of patience he could muster. Slowly, over time, he was allowed to take carving tools and scrap leather home to practice and eventually, one thing led to another. It was very much like a third-year surgical rotation, I've decided.

For my part, I spend a great deal of time watching and keeping my hands to myself. Students have two primary tasks in a rotation like this. The first is learning how to refrain from contaminating yourself or anything and anyone else in the operating room, no small feat in itself.
One false move and you've touched something you shouldn't or bumped into someone you wish you hadn't. Mikhail Baryshnikov would cringe at the choreography.

The second task is harder, perhaps hardest of all. It entails practicing knot tying and suturing at home, standing next to the surgeon for what feels like forever, waiting to be invited to participate at the most rudimentary of levels, i.e. holding a retractor, snipping sutures, or if you're lucky, stapling an incision closed. If you're really lucky, like I was the other day, you get to guide a laproscopic camera, which has been inserted through a plastic tube called a trochanter, into a patient's abdomen, while your preceptor removes an inflamed gall bladder. It felt like I was moving up in the world.

Seriously, you want very badly, as a student, to do something that matters. It's one of the primary reasons we attend medical school in the first place. In a specialty like surgery, however, and truthfully, in all medical specialties, we have to learn the value of humility. We're students, after all, and the only proficiency we possess at this point in our education is that of memorizing large quantities of material, a skill which, our preceptors inform us, has limited applicability in the world of real medicine. It's all about learning how to wait your turn and appreciate every opportunity to do more.

Horace Mann wrote, "More will sometimes be demanded of you than is reasonable. Bear it meekly, and exhaust your time and strength in performing your duties, rather than vindicating your rights." Eventually, your time will come and those who've witnessed your commitment and devotion, will remember you as one who worked your heart out and didn't complain. As my father would say, it's called paying your dues.


(Creative Commons image of Charlie Brown shopping for a Christmas tree by KIT via Flickr; The River lyrics copyright by Garth Brooks)

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Sunday, November 13, 2011

I Heard Sleigh Bells


She must have been about four, old enough to go shopping with mommy but still too young to make the entire trip without being carried to the car afterward. She was holding her mother's hand, waiting, as was I, for the Portland Williams-Sonoma to open. If the holidays are magical -- and for me they definitely are -- Williams-Sonoma has a corner on the market. From peppermint hot chocolate to china to cookie and pie cutters (my target purchase this time) -- I wonder sometimes if they don't have a direct line to the North Pole.

I realize Thanksgiving is a couple of weeks off, and you're right, it really is too early to be writing about Christmas. I mean, Madison Avenue is bad enough. Turn on the tube two days before Halloween and from the ads, it appears Thanksgiving is nothing more than a minor bump on the road to December 25. But what was about to happen in front of Williams-Sonoma would be enough to make even the most jaded forget about the date and simply be glad the Holidays are here at last.

I was standing with my back to a long hallway leading to the mall offices, preoccupied by my sweet, diminutive fellow watcher and waiter and her fascination with the window dressings. A toy train bearing the name, The Polar Express, rolled round a track decorated with artificial pine bows, green ribbons on red packages, and a tiny town replete with snow-capped mountain. She couldn't steal her eyes from it and neither could her mother -- there they were, two little girls, hand in hand, riding The Polar Express.

Suddenly, I heard a loud, "Ho! Ho! Ho! M-e-r-r-y Christmas!" and quickly turned to see Santa Claus step from the hallway into the mall. Oh yes, you bet I smiled and waved, I never miss a chance. He smiled and waved back, then greeted other shoppers who stopped at the sound of his voice to wave.

Then, I heard something else, a rapidly indrawn four-year old breath that made me look down. With eyes like saucers, she whispered in awe, "S-a-n-t-a." At first, I wasn't sure how it would all unfold -- did he notice her? Of course, he did, he's Santa, he knows when we are sleeping, he knows when we're awake -- not a child on the planet goes unnoticed by him and that includes this one. His two female elvish helpers continued on to his "workshop," unware he'd halted in front of Williams-Sonoma and knelt down on one knee.

He reached a mitted hand to his face, thoughtfully stroking a beard I'm absolutely certain had to be real, and softly said, "Merry Christmas, Jennie." She looked up at her mother, whose face was a study in amazement, then broke free and ran into his arms.

I didn't hear what was spoken, that's between she and Santa, and maybe nothing was. Maybe her actions said everything. I know they spoke clearly enough that when he released her and tenderly touched her hair, rising to his feet he looked at me with eyes moist with tears. Yes, Virginia, Santa has a heart, you can be sure of it.

Something told me only a fool would let this moment pass, so I followed after him and laid my hand on his shoulder. "I'm sorry to intrude, but..."

He interrupted me and said, "You want to know how I knew her name. Well, Beggar -- yes, I know yours, too -- after a few hundred years at this, you start to develop a pretty good memory. Merry Christmas." Then he smiled once more and winked.

I could have sworn I heard sleigh bells as he walked away.


(Creative Commons image by dkjd via Flickr)
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