Tuesday, December 27, 2011

Doc Beggar's Little Pal

I'd almost resolved 2012 would be the year of the new computer. With graduation on the horizon and residency afterward, one starts thinking about transitions, and whether it's time to bite the bullet and upgrade. On top of it all, my laptop has had "issues" lately, At first, it was a malfunctioning touch pad requiring me to hold down the "alt" key in order to move the cursor. Then the "d" key began producing "da" each time I struck it. Finally, the "a" key joined in, sometimes psychotically producing a line of letters that ran off the page and sometimes refusing to work, period, no matter how hard I pressed. What to do?

Well, my computer is off-warranty, restricting my options from the outset. Having worked on my own car in the days when engine size was measured in cubic inches, I decided to search the Dell website and see if I couldn't fix the situation myself. That led to installing a host of new drivers, none of which had the slightest effect on the keyboard, naturally. So, I reinstalled the original keyboard driver two or three times from the CD that came with my computer. And did that work? Uh, no, as a matter of fact, it didn't.

Next, I called Dell tech support. Actually, my first instinct was to call, but I assumed they'd tell me my warranty had expired and there was nothing they could do unless I had a credit card handy. Wrong again, they were nice enough to take a look via computer sharing before politely informing me I needed a new keyboard. Not a new one exactly, because my computer is so dated, new parts are no longer produced. They meant a rebuilt keyboard, i.e. newer than the one I had.

All the while, I'm still thinking about a new computer. I felt badly about it because this one and I have been through a lot. We're veterans of three, going on four, years of medical school and together we've gotten a book published and written several hundred blog posts. That's a lot of history, you know? The thought of reformatting "his" hard drive and erasing six years of my life, despite having saved the data on a backup drive, didn't sit well. It was too much like breaking off a friendship when the going gets rough. Besides, that's when friendship counts the most or so I believe, anyway.

A good night's sleep later, I decided to make a final stab at Google, this time searching the error code I'd gotten from running a diagnostics program. The result indicated a stuck key. Can it really be that simple? I wondered. After prying the cover off the "a" key and thoroughly cleaning its constituent parts, I restarted the computer, crossed my fingers and held my breath. Not only had the "a" recovered its sanity, the "d" no longer typed "da" and my touch pad functioned normally. Forget a new computer, the one I have is "back" and I'm happy as a kid who's discovered reindeer hoof prints in the snow on Christmas morning.

Sure, fixing the problem on my own felt good, but what delights me more is not having to replace Doc Beggar's Little Pal, as I refer to it. It's sort of like a Guild steel-string guitar I packed around throughout college, seminary, graduate school, and beyond. Despite being battered and scratched, it plays well and its sound reflects the depth and character of mature wood. I could have bought another, I suppose, but even if I had, I'd still play this one. We've traveled too many miles and shared too many lonely nights, to call it quits over a few blemishes.

(Creative Commons image of a Guild headpiece by bijoubaby via Flickr)

Sunday, December 25, 2011

A NORAD Christmas Reprised

A relative of mine once said, a little sadly, "Christmas is for children." I was young at the time, how old I'm not sure, but I remember thinking, Christmas isn't for adults, too? Looking back, I think he must have felt he'd lost something along the way, a loss he felt most acutely at Christmas.

Entering the holiday season with baggage from long ago isn't unusual. Often, adults find tears come as easily as smiles. The Christmastime when I was young, the magic and the wonder, but colors dull and candles dim, and dark my standing under,
isn't just a song lyric, it's a reality for many. They're the kind of things that got me thinking, back in 1999, about Christmas when I was young and how my parents and I spent evenings like this one with my aunt and maternal grandmother. One thing led to another, and the story that follows was born. Some elements are true in the sense they actually happened, others are made up, expressing wishes of the heart as much as anything.

It's title stems from one of those real events, the night I first heard of NORAD tracking Santa. I remember it as though it was happening at this very instant and it's something I'll never forget. I'm sure you've had similar experiences that you treasure in much the same way. Originally posted at Christmas in 2009, I'd like to offer it again with the hope that this Christmas is all you've dreamed it could be.

A NORAD Christmas...

Christmas Moon 2007
I can't help it -- oh, I guess I could, but I don't want to -- Christmas is my favorite season. Somewhere around Halloween I come down with a serious case of "holiday fever" and don't recover until well after New Year's. Each holiday brings a spike in my temperature until, by December 25th, I feel more alive than at any other time of the year. It's as though I'm caught up in something that has a life of its own: a season of changes, a time for new birth, a time for starting over, for filling Life with mirth.

One particular Christmas Eve forces itself into my memory each year. It beg
an as did most when I was a child. Early in the evening, my parents and I gathered presents, bundled up against the cold, and drove to the home of my maternal grandmother, miles away in the city. We lived in the country and the city lights formed a dim halo about the crest of the hill that rose slowly from our front door. The night sky was clear and starlight glittered on the newly fallen snow coating the farms and fields along our way.

My grandmother lived in a two story, white stuccoed survivor of the Roaring Twenties, with a huge arched window facing the street. In anticipation of our arrival, she kept the house dark except for the lights from her tree pouring through the window and onto the flagstone walk at its feet.

I had scarcely gotten out of the car when my maiden aunt burst breathlessly from the house. She had not-quite-flaming red hair, and when I think of her now, fire engines come to mind. My aunt displayed incredible energy in all she did and whenever a problem threatened to burn out of control in my life, she was always there with her "fire hose" to lend a hand. Sweeping me up in her arms, she asked, "Did you write your letter to Santa? Did you mail it in time?"

"Yes! Did you?"

"Oh, yes, I mailed mine a week ago!" she replied, her eyes bright with laughter.

Greeting my parents, she ushered us into the house, then rushed from lamp to light switch, flooding the old house with light. My aunt loved Christmas and spent days preparing for the holiday. The dining table would be laden to overflowing with cold cuts, marshmallow salad, peanut brittle, almond bark, and my favorite, spearmint ribbon candy. With carols playing on my grandmother's aging Telefunken stereo, a gift from her youngest bachelor-son, we visited, snacked, and opened presents.

Finally, my grandmother growing festively weary, we gathered our coats and stepped out into the night for a final glimpse of the stars before driving home. My aunt leaned down and whispered, as always, "Do you suppose this will be the night we see him? I'm listening for sleigh bells..."

The long drive home made me sleepy and I'm sure I must have dozed because the next thing I knew, my father was carrying me into the house. The hour was late, but we stayed up to watch the news and relax. I sipped hot chocolate and read the comic pages from the morning paper when my father nudged me.

"Listen to this!" he said.

I stopped reading and looked up as the announcer reported that an unidentified flying object had been sighted over the Arctic and NORAD, the North American Aerospace Defense Command in Colorado Springs, was tracking it. I became immediately excited because I loved science fiction and was certain it had to be an alien craft.

"Just wait," said my father, "there may be more."

Sure enough, moments later, the announcer interrupted the weather segment with an update. "NORAD reports the object sighted over the North Pole has been identified by Air Force jets based in Alaska. It is, in fact, Santa and his reindeer, and the pilots have been instructed to escort him safely into United States air space."

I looked at my father with what must have been absolute rapture. Not only did my aunt and I believe in Santa Claus, so did the Air Force -- more than that, they'd actually seen him! If I might have ordinarily had difficulty sleeping on Christmas Eve, you can be sure I had even more that night.

A long time has passed since I've spent a happy Christmas with my aunt and grandmother. Both of them are years gone and those evenings live in memory. Thankfully, however, some things don't change. After Christmas Eve candlelight church services, my wife, our children, the dogs, and I curl up with hot chocolate by the fire to watch the late news. When the announcer faithfully reminds us that NORAD has sighted a sleigh in the northern sky, the kids turn to face us with eyes like starlight and smiles even brighter.

And every year, once the house is quiet and the kids asleep, each one snuggling a well-loved dog, my wife and I step outside for a final glimpse of the stars, and we wonder, will this be the night...?

(Copyright (c) 2009 by Patrick W. Conway)
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Saturday, December 24, 2011

"Merry Christmas," She Said.

Not wishing to remove my gloves in the cold, I said, "I'll catch you on the way out." It would be simpler, I thought, to keep my wallet handy once I'd finished at the cashier's. She smiled and nodded, not missing a beat, our conversation another verse to the song she played inside her head.

I didn't have to say anything; her back was to me, I could have walked on, completed my business, then done as I intended. No one needed to know; none would be the wiser.

Except that I wanted her to know because so many just walk on by. I almost forgot myself, until the last second when I saw her again and remembered. I marveled at her patience, at her consistency. It wasn't like she expected everyone to stop; only those who were supposed to. She was on her appointed rounds, waiting for her people to show up, even if they didn't realize they were hers until that very moment. In the meantime, she kept on, ringing what I heard as Jingle Bells and she maybe something else, her eyes peeking over the rim of a muffler wrapped round her face, twinkling in good faith.

I would get impatient, I'm sure. Impatient, disgruntled, discouraged and then cynical, passing judgment, playing God. It would be easy to do, to forget how easy it is to be guarded in times like these, to blame the unfortunate for their misfortune, to cross to the other side of the road like the Priest and the Lawyer once did and a Good Samaritan didn't.

A Samaritan, by the way, who wasn't like we paint him, one of the good guys going about doing good deeds at Christmas, someone you'd like to have living next door or upstairs. He was a Black man in 1950s Alabama who dared touch a White woman who'd been raped and left for dead. Or, maybe she's homeless, living in a tent constructed from cardboard boxes. The Good Samaritan was like that, unacceptable by the book, but caring anyway.

She was also a Salvation Army Bell Ringer on a frigid Portland morning waiting for me to step up and be counted. To stuff a bill in her bucket. To render aid. To follow her example, to not cross the street and walk on by.

"Merry Christmas," she said.

(Creative Commons image by miliu92 via Flickr)

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Sunday, December 18, 2011

It Felt Like Warp Drive

It reminded me of a scene toward the end of Star Trek III: The Search for Spock. You remember, the one where Kirk and Crew hijack the Enterprise to rescue Spock, whose body has been re-animated by the Genesis Wave that was set off on the Genesis Planet. I was tempted to say, "re-activated," but that sounds too mechanical, sort of what you'd do to Spock's successor, Data, in the second generation Star Trek. I'm glad the third generation is really the first generation re-discovered. I enjoy Jean-Luc and all, but at heart, I'm a purest.

It's the same film, by the way, in which Dr. McCoy delivers a line I'd love to have written. The Enterprise is going down in flames and Kirk says, "My God, Bones, what have I done?" McCoy replies, "What you had to do. What you always do. Turn death into a fighting chance to live." I think that's one of the best lines in film, maybe in literature, maybe even in history. Sigh.

Anyway, where were we? Oh, yeah (blush), sorry for the digression. So, I woke up this morning, somewhere around way-too-early with the sensation of cold on my face, nose to forehead. It was the same kind of cold I've experienced on winter Scouting trips, and so have you, if you've ever gone camping or backpacking and felt nature's frosty, chilly, barely-dawn breath on the portion of your face that doesn't fit inside your mummy sleeping bag and asked yourself, Why was it, once again, I thought this was supposed to be fun?

Well, at first I thought a window was open and when my pager sounded its dweedle-DEE-de rendition of reveille at 5.30 (I've got to turn that thing off, it's Christmas vacation after all), I summoned the courage to get up and close it -- the window that is -- except it was already closed. Next thing was to head for the bathroom and then turn up the thermostat. Except, instead of its familiar varoom, the furnace only clicked.


I've heard this before, I thought, and decided it meant we had run out of fuel oil. Except the date on my latest bill said we'd just gotten a delivery. Nobody uses 150 gallons of oil in four days. Not even in Maine in the dead of winter unless they're drinking it. Since I wasn't, in a flash of medical student intellectual acumen that would give Mr. Spock Logic-Envy, I concluded it had to be the furnace. Unbelievable.

With visions of phoning the repairman dancing in my head and flashlight in hand, I stepped into the dank depths of the basement and weaved my way through the hanging gardens of cob webs to face the music. A glance at the breaker box confirmed the furnace, installed years ago by the Dead-Head Oil and Gas Company (owned and operated by a Grateful Dead fan, naturally), was getting power, so what now? Almost fresh out of ideas I noticed a little brass plaque detailing instructions about what to do when the furnace hasn't started up. Well, duh.

Step one, check the power. Done that. Step two, check the oil. Done that, too, please tell me something I can't figure out on my own. Step three, press the reset button -- only once. What happens if you press it twice, I don't know, but I wasn't interested in finding out. As I reached my finger toward the single button I could find, it came to me. This is just like Mr. Sulu, Mr. Scott, and Mr. Chekov, trying to decipher Klingon in order to engage warp drive at the end of Star Trek III. The Genesis planet is exploding and Larry, Moe, and Curly are at the helm. Finally, Sulu throws a switch and announces, "Sir, if I'm right, we have warp drive." Kirk responds, "Go, Sulu!" and they're off.

And so was my furnace. On, I mean. Not off, not as in warp drive or bound for Vulcan, but on, as in working. Okay, maybe you'd have to have been there. It sure felt like warp drive to me, though.

(Non-free low resolution image from Star Trek III: The Search for Spock, by illustrator Bob Peak, copyright presumed to be held by Paramount, 1984, used to identify the film cited herein, via Wikipedia)

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Saturday, December 10, 2011

Door Number Three

Newborn child, seconds after birth. The umbili...Five days ago, six if you count Monday and orientation, I walked onto the obstetrics unit, knowing little more than Prissy (Gone With the Wind, 1939), who freely admitted she knew "nothin' about birthin' babies." I guess that means I knew next to nothing, which is okay; if I knew at the beginning of this rotation what I hope to know at the end, there wouldn't be much reason for what comes along in between, would there?

As it stands, I've already learned a few things, among them that I'm not inclined to drop a slippery newborn despite the fact, as a kid playing Little League, "Butterfingers" could easily have been my nickname. There's something about holding a baby who's just taken its first breath, that makes you hold on for dear life. Maybe it's parenting instincts kicking in, but the thought of losing your grip doesn't cross your mind. Holding them close with a quick, welcome-to-the-world snuggle in the crook of your arm, while passing them to the NICU (neonatal intensive care unit) team, you bet, but letting them slide through your fingers? Uh-uh.

And then, there's the matter of learning about the mess. Childbirth really is messy business. Television prefers spit and polished, shiny clean new babies who don't make anyone squeamish. Not so Mother Nature. There may be some blood, especially if junior's exit from the womb produces a tear in mom's vagina. There's amniotic fluid when her water breaks, though that usually occurs earlier, unless she's having a C-section, in which case the flow of amniotic fluid is more like a flood. To top it off, there's meconium -- baby poop -- mixed in for good measure. Martha Stewart would cringe.

Honestly, though, I don't mind the mess. Life is messy. Personally, I think trying to eliminate the messiness nudges more people toward neurosis than the other way around. It certainly is a driving force in narcissism, where the appearance of perfection is all-important. Babies have an entirely different perspective. Forget all that other stuff, okay? Mom was toasty warm, will someone please wrap me in a blanket? Ah, there we go, that's better. Mm. Thank you very much.

What I'm particularly enjoying about this rotation thus far is the tacit understanding that some things can only be learned here. Internal medicine teaches you how to write a good clinical note, surgery how to behave in the OR, pediatrics how to deal with kids and parents, psychiatry how to manage things going wrong, and then rural and family med puts it all together. None of them, however, specifically target birthing, prenatal care, or women's health (gynecology). So, in a sense, it's expected that a student is literally starting over at the bottom. You can use skills gained elsewhere to a certain extent and yet, so much is totally new. Every day is pregnant (pardon the pun) with possibilities and you never know what's waiting behind door number three.

(GNU Free Documentation image of a brand new newborn via Wikipedia)

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Saturday, December 3, 2011

No Claims to Courage

Well, as of yesterday, surgery is over. I passed my exam, packed my bags, and said adios to the little two story house on the banks of Long Pond in central Maine, that has been home away from home since mid-October. Thursday marked my last shift on the surgical unit and it felt wistful, saying goodbye to people who've become coworkers as much as teachers these past six weeks.

Technically speaking, my instructors have been surgeons: general surgeons, urologists, obstetrician/gynecologists, orthopedists, and neurosurgeons. Quite a range when you consider the size and scope of the hospital. But the nurses and surgical techs were teachers, too, and good ones. And I ought not forget the anesthesiologists and nurse anesthetists. Together, they taught me how to behave as a member of a surgical team.

It has to be difficult, being regular staff and having a newbie walk through your doors eight times a year. Friday, one leaves and Monday, another shows up. Friday's guy has finally figured out how to find the bathroom without having to be shown and Monday's doesn't know what a bathroom is yet. It's not quite that bad, but you get the idea. There's a constant flow of change. Students are a "complete unknown," as Dylan put it, rolling stones gathering as much moss as they can before rolling on.

When I began this rotation, it was with the understanding that a community hospital wasn't exactly the best place to learn about surgery if I wished to become a surgeon. Opportunities for observing and participating were, of necessity, directed toward the ordinary or the mundane. I suppose that's true, but I gained a great deal in spite of the presumed limitations. One of my pastoral mentors reminded me, as I was leaving for seminary, "You can learn something from every preacher, so pay close attention." That advice holds true for rotations and this one was no different.

For instance, I learned how to intubate, i.e. insert a plastic tube into the mouth of an anesthetized patient, past the epiglottis, locate the vocal folds, and slide the tube between them, ensuring an adequate airway during surgery or at other times when a patient needs ventilatory support to breathe. I learned how to place a laryngeal mask airway tube when intubation wasn't necessary. And I learned how to start an IV line. All good tools to stow in my doctor's bag alongside the reflex hammer and stethoscope.

I learned how to take a leap of faith, not once but twice, by incising a patient's belly with a knife sharp enough to cut just by looking too closely at the blade. I also learned the cost of hesitation. Surgical time is billed to the tune of twenty-five bucks a minute. With a mere 60 seconds constituting each minute, one second wasted in unnecessary indecision is accompanied by the sound of 42 cents clinking down the drain. Standing alongside my patient I had 84 cents max to decide whether I had the guts for this kind of work or not. You wouldn't think faith could be thus quantified, would you?

I think my father would have enjoyed talking about this rotation. He knew some experiences have to be lived to understand, but he'd encourage me to try, anyway. Just the effort, sometimes, takes us places we'd never visit otherwise. Incising a half inch long swath into a belly that had held children cut deeply into my own fears. Of what, I'm not sure, but I came out of the surgical suite feeling braver than when I went in. e.e. cumings wrote, "
It takes courage to grow up and turn out to be who you really are." While I make no claims to courage, I do think I managed to do some growing up the last few weeks and I have a lot of people to thank for it.

(Photo of Long Pond at sunset copyright 2o11 by the author. Like a Rolling Stone, words and music by Bob Dylan, copyright 1965)

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