A Series of Unfortunate Events

No one wants to hear good news.

Take the wild popularity of Daniel Handler’s A Series of Unfortunate Events, the commercial and critical success of Modest Mouse’s Good News for People Who Love Bad News, or the voracity with which we consume any television or newspaper reporting of tragedy—which is to say, most of the reporting. It might seem that we are genetically encoded to seek out suffering.

If such is the case, I’m happy to recount that this past week was Miserable with a capital M. On Monday I am in the hospital until 11 PM after transferring one critically ill patient. Her O2 sat drops from 98% to 60% and her systolic blood pressure goes from the110’s to the 60’s. We rush to give fluids and maintain oxygenation. Tuesday I stay again until 10 PM to help with a second emergency transfer, a man whose blood refuses to clot and we cannot wake up from breathing assistance. On the occasions I am able to make it to my own outpatient clinic, I feel overwhelmed trying to manage medically what I so often see as failures of society: failure to prioritize grade-school education over tax breaks for the super-rich, failure to protect local farmers from having to compete with an influx of cheap packaged food products, failure of insurance to cover basic, proven therapies that would not only improve health but also save money by keeping people out of the hospital.

Yet if tragedy is our daily bread, we also seek out humor, hope, good-ness. We marvel at the story of the 4-month old baby pulled from the wreckage, alive, a full 96 hours after the tsunami hit the coast of Japan. We celebrate the pilot and crew who manage to land a plane with 259 people on board after both engines fail (LL and I just finished listening to Atul Gawande’s The Checklist Manifesto on CD.) We laugh with relief when Jackie Chan uses a chair and a ping-pong net to defeat an attacker twice his size.

In my series of unfortunate events this past week, there is a moment that I hold on to for hope. It is not the phone call I receive on Thursday that the man we transferred is awake and doing quite well, though that is unbelievably good news. It is not the patient who presents with a stroke and recovers quickly. Nor is it the small times when I get to go home and sleep.

Rather it is the moment of calm in the middle of Tuesday’s transfer when, with the indispensable help of our anesthesiologist, we have stabilized the patient enough to wait for the flight crew. For a few minutes, I get to talk with the son about his dad. I get to hear about his move out to this tiny town and his years working as a diesel mechanic. I get to hear about the time up in Alaska when he pulled in five halibut—and then that night couldn’t lift a drink up to his lips because his arms were shaking. How he was a simple, hard worker who spent too much of his life standing on hard concrete lifting heavy objects.

Then the flight crew arrives and it is all medical again: how much fresh frozen plasma was given over what time frame, the exact lab values measuring bleeding time, the results of the chest xray.

But for those few minutes, waiting there with the patient’s son and my colleagues, we are able to know that we have done everything that we can do, that there is nothing else that we can do, except talk to each other, connect, as humans.

That is good news indeed. Even for people who love bad news.

On writing

This is going to be a short blog.

A survival blog.

An I'm-overwhelmed-and-don't-have-time-to-write-right-now blog.
This is an after-the-fact blog, a take-a-deep-breath blog, a there-is-so-much-going-on-in-the-world-blog, a how-could-I-possibly-sit-still-for-even-a-moment blog...

An essential blog.

This blog, this writing, this act of creation, needs to take place. For me. For my own sanity, for my own survival. This act I must do. This moment I must take.

There have been so so many others who have said the same thing much better. Under much more trying circumstances. Why create? Why write? Why think?

It is Nelson Mandela writing for 30 years in the prison of Apartheid.

It is Georgia O'Keefe noticing, really noticing, a flower. The skull of a cow.

It is Paulo Freire engaging, teaching, revising, communicating.

It is Martin Luther King, Jr., in an Alabama jail;

it is Henry David Thorea in a Massachusetts jail;

it is Arundhati Roy unwriting a dam with her pen.

It is Andrea Gibson, tiny as the universe, standing up on a lit stage in a darkened room:

"we have to create
it is the only thing louder than destruction
it is the only chance the bars are going to break,
our hands full of color
reaching towards the sky
a brushstroke in the dark
it is not too late
that starry night
is not yet dry"

Forgive us our trespasses

According to my 1966 Reader's Digest Great Encyclopedic Dictionary, the word trespass derives from the Latin trans, beyond, + passare, to go. Similar combinations yield transgress, from gradi (to step), transcend, from scandere (to climb), and the related exceed, excel, surpass, surmount, outdo.

Of these "go beyond" words, only trespass and transgress have taken on negative connotations, and these mostly in the context of law and religion. But what if the law or the religion is unjust? Then is to trespass not to excel, to transcend?

Disclaimer: Even as my heart races with excitement and my mind jumps to Thoreau's principles of civil disobedience, I have a confession to make. This entry was not inspired by causes any greater than skiing and parkour. A couple months ago LL and I committed a barbed-wire trespass in the pursuit of telemark ski turns—further confession, I committed the trespass and dragged LL along with me. Then a few weeks ago, inspired by a Sports Medicine CME at which I was introduced to the label "parkour" for the brilliant environment-interactive free-running highlighted in the French action movie District B-13, I scaled a 30-foot concrete wall using the overgrown spillover branches of a tree only to find myself in one of Seattle's gated communities giving an impromptu parkour explanation to one of Seattle's gated community watchmen.

But even as I make this disclaimer I cannot help but think of what is happening in Egypt and Libya, not to mention Wisconsin, of the protest against unjust governance, the trespassing and transcendence happening with each voice raised. One of Thoreau's central points in Civil Disobedience is the connection between the small, daily, unexamined allegiances most of us contribute to the status quo at home, and the actions that that same status quo achieves remotely. With our wages we condone harm. By our taxes, by our purchases of household items, by our silence, we enable the violence that our government and our corporations commit.

"I quarrel not with far-off foes, but with those who, near at home, cooperate with, and do the bidding of those far away, and without whom the latter would be harmless. ...It is not so important that many should be as good as you, as that there be some absolute goodness somewhere; for that will leaven the whole lump."

Before writing this today I had not read Thoreau’s essay. I would not have been able to articulate any of his ideas, beyond this: “Unjust laws exist: shall we be content to obey them, or shall we endeavor to amend them, and obey them until we have succeeded, or shall we transgress them at once?” But there is so much more here! Set in opposition to slavery and to America’s imperialism in invading Mexico, Civil Disobedience questions the nature of a government that promotes stagnation over reform.

“Men generally, under such a government as this, think that they ought to wait until they have persuaded the majority to alter them. They think that, if they should resist, the remedy would be worse than the evil. But it is the fault of the government itself that the remedy is worse than the evil. It makes it worse. Why is it not more apt to anticipate and provide for reform? Why does it not cherish its wise minority? Why does it cry and resist before it is hurt? Why does it not encourage its citizens to be on the alert to point out its faults, and do better than it would have them?”

It would be easy and not untrue to say that we are living in both scary and exciting times. Even as the few work to consolidate power—a rabid dictator in the Middle East, a no-less rabid governor in the Midwest—there is a recognition from the many that this is unjust.

What would be untrue is to call the situation novel. It is the struggle between the propertied and the property-less. It has been going on ever since men began to lay claim to particular pieces of earth and extract everything possible, rather than living in equilibrium with ourselves and our world. What Thoreau does is to call our attention to how much our wealth comes at cost to others, in a way that has always been true but has become much less transparent. It is simple (and requires no change in behavior) to look backwards and see that the slavery of the 19th century was wrong. It requires more work to make the connection between a Coke I might drink or a shirt I might wear or a computer I might type on, and the often unjust (not to mention environmentally unsustainable) conditions under which those items were produced.

"It is not a man's duty, as a matter of course, to devote himself to the eradication of any, even the most enormous, wrong; he may still properly have other concerns to engage him; but it is his duty, at least, to wash his hands of it, and, if he gives it no thought longer, not to give it practically his support. If I devote myself to other pursuits and contemplations, I must first see, at least, that I do not pursue them sitting upon another man's shoulders."

If the injustice of our world requires our daily support to continue, then it is time for us to practice parkour. It is time to trespass, to transgress, to excel.

Separation

How do I begin to write? How do I, a mid-thirties white male physician who is happily married to the love of my life, begin to write about a 20-year-old Native American woman, incarcerated as a bystander to a violent crime, who gave birth 40 hours ago and must now give up her baby?

The first thing to say is how very little I know about this woman.

I don’t know the story of her family, other than that there is a history of substance abuse. I don’t know the details of her own birth, whether there was alcohol involved in her mother’s pregnancy, if she was born early, if she was breastfed. I don’t know if she was wanted or loved or ignored or abused or some of all of these things.

Our electronic medical record could be called comically inadequate, except in this case the inadequacies are anything but amusing. Her chart lacks a Y/N checkmark beside “Less than 8th grade education”, and the checks for “Alcohol” (N), “Drugs” (Y) and “Tobacco” (N) are the opposite of what she has told me—she admits to alcohol and tobacco around the time of and possibly after getting pregnant, but denies drug use. There are negative checks next to “Abusive relationship” and “Cats” (cat feces being a risk for a parasite called Toxoplasmosis, although in developed countries a more common source of this infection is from consumption of undercooked or cured meat or meat products).

There are affirmative checks next to “No family support,” “Poor living environment,” and “Significant social problems.”

What I can speak to is what woman has been through. When I assumed her care late in the second half of her pregnancy, she had just had preterm contractions and been told that she was a bad mother to the fetus for not taking a medicine that was making her sick and for which there is no evidence of improved outcomes. For every clinic visit, she would be escorted into the exam room shackled at the ankles and wrists. Not one but two generously-proportioned guards would stand outside while we talked. For her delivery, she was allowed to have no family or other support present.

To their credit, all of the wardens and nursing staff always treated her kindly and courteously.

At our first visit this young woman was very guarded. As the number of visits increased both in number and frequency—she had several more scares for early labor—she seemed to open up little by little. Occasionally she even smiled. Whether she grew to look forward to our prenatal visits, I’ll never know.

Because of horror stories she’d heard about epidurals, she wanted to “go naturally” when it came time, without medicine in her spinal fluid to numb her pain. LL and I had just watched The Business of Being Born and I supported her decision; at the same time I did my best to dispel the myths regarding epidurals.

2 days after she’d made it to term, having had several previous visits to the hospital for which she was “ruled out” for labor, her bag of water broke and her cervix began the often-tortuous dilation to 10 centimeters. She stuck with her decision to not have an epidural. Throughout the labor she remained quiet, stoic, and polite. Every time I came in to talk with her she asked appropriate questions. Mostly she would be looking down with her face a blank slate, but on rare occasions she would let a smile escape, and even more rarely let her pain show. As I would be walking out of the room, she would invariably look up and quietly say, “Thank you for everything.”

17 hours, several bags of Pitocin, 5 doses of GBS-prophylaxis antibiotics, a last-minute epidural, internal monitoring, and 20 minutes of pushing later, she delivered a 5 pound 7 ounce beautiful crying baby girl.

For the next precious 40 hours she got to hold her baby. The baby was more consistent with being 2 weeks early than being term, and had difficulty latching onto her breast to feed. But it did not become febrile, lose more than the accepted 10% of its weight, or become jaundiced. Somehow through all that this woman had endured her baby was healthy. And in her eyes, for this baby, was something I had not seen. It was love. It was pure and simple love.

I again find it difficult to write. For me it was hard but easy this morning, when she had to go back to jail and her baby had to go to a grandmother somewhere to be taken care of: I am there, I cry with her, I leave. I carry on with my life. I cannot know, cannot imagine, what this woman went through. Is going through. Right now everything is up in the air. If all goes well for her in court, she and her baby could be re-united as early as the end of next week. If not it could be months, or years.

Ojala that it goes well. Ojala that it goes well.

God's country

It is Wednesday morning. This is my day off from work.

I drive in to work and work until noon. When I leave I am headed for a funeral, but instead turn my car around on Highway 97 and take a left up Cameron Lake Road. As I climb the hill the snow deepens and the sagebrush is joined by the occasional ponderosa pine. The small fragments of light offered by mid-December are gathered up carefully by the new snow and amplified, reflected, a thousand million tiny suns making the short day bright. At the top of the hill I pull over and climb out to take in the view.

The air is colder here and I haven't brought my hat or jacket; I can only stand outside for a few moments before returning to the valley, to the funeral, to people and community and the warmth offered by the shared experience of living and dying. But for this instant I am alone with the indifferent and utterly beautiful landscape.

Directly below me a small lake is identifiable as a flat expanse of uninterrupted snow, which in this rocky terrain can only be explained by water. Below that a bluff blocks my view of the Okanogan River, and in the places where I can see further, the river itself is mostly hidden by trees. Wherever there are trees there are houses, at least in the valley floor, and from here the towns of Okanogan and Omak appear to be only slightly dense accumulations of the the farm buildings that dot the river's path to the north and south. But for the most part what I am looking at is wide-open space. It is rugged country writ large, basalt cliffs rising to timbered slopes and painfully white peaks, and all human endeavors look small and transient by comparison.

I think of the writer Ed Abbey, describing the desert southwest he so loved, God's country, Abbey's country. The same wide-open beauty.

In a few minutes I will drive down and cross the river and go into a church. I will hear about how wonderful God is to have given us this time here on earth, and I will find it hard to argue. The pastor will tell me that we are here to glorify God and be thankful, and who am I to argue? I will hear this message, spoken perhaps in different words than I would use, but expressing the same idea. We are here to love one another. We are here to be a part of this beautiful world, and if given the opportunity, to leave it a better place than when we entered it.

In a few minutes I will hear all of this, and be grateful for the human companionship, the hugs, the offers of pie and coffee, the warmth. In a few minutes.

Right now I am happy to just be here on the ridgeline with my thoughts.

Snow is a force that gives us meaning

As a kid growing up in eastern Oregon I loved snow. No matter how much it snowed, it was never enough for all the skiing, sledding, snowforts, snowball fignts and snowjumping (jumping off of the roof into a big snowpile) which could be dreampt up by my siblings and I. In fifth grade the snow reached over my head, the closest it ever came to my imagined quota. Now, 25 years later, I again find myself in snow country. And once again I want more.

This morning it snowed a couple inches while I stayed inside and fiddled with the new projector that LL and I have decided to treat ourselves to. Now that that is done--as with all projects remotely electronic and/or mechanical, it always take way longer than expected--I am temporarily at a loss for what to do. Not that I don't have any number of things I could/should be doing. But none are as fun as...

Of course! Snow. Outside I go, shovel in hand, to tackle the driveway.

As I push snow my mind relaxes. The task is simple and at hand. The reward is tangible, measurable, satisfying. Even as I clear a path, I wish for more: as long as it snows, I will have something which must be done, just as after finishing the driveway, I have to take LL's rig in for studded tires.

I wonder--not yet having read Chris Hedges's War is a Force...--if our urges toward violence might not be taken out more benignly on snow. We (and by we I mean of course I) have within us (me) the occasional urge, borne of the daily stresses accumulated by living an imperfect life, to destroy something. Snow is beautifully unique in its range of accommodation. Like water it can be hit and pushed without harm to do-er or do-ee, but in a way that water can't it can also be used for creation. In skiing and sledding, the desire for speed, even reckless speed, can be satisfied with yet a soft landing for crashes. In moving snow, there is unfettered access to the physical labor that is so often lacking in our lives. Maybe we all could use a little more snow.

Maybe, too, part of my love affair stems from the sense of something fragile and vanishing. We are in a La Niña year so it's supposed to be colder and wetter. But the numbers implied by global warming do not bode well for snow in the years to come. Snow, at ever-higher latitudes and elevations, may be an endangered species.

In which case, maybe snow could become the icon that finally galvanizes the floundering (or dead, as per the title of Hedges's latest, Death of the Liberal Class) progressive movement into action.

Ok, so that's a stretch. But such recent events as the failure to pass I-1098, which the 98$ of people who DON'T make more than $200k/yr would have benefited from, against a backdrop of huge cuts to essential services in healthcare and education, have me grasping at straws. At fragile and ephemeral things. At snow.

I'll write again when it's over my head. Until then let it snow!

Pumpkin soup

1 large pumpkin
A few ripe tomatoes
Hot peppers--3 or more, depending on BTU level
1 freshly picked coconut, or, if you don't live where coconuts are freshly picked, 1 package of processed coconut product
3-7 cloves of garlic
fresh ginger root, grated
2-4 orange and/or red bell peppers, depending on size
some ground nuts (e.g., hazelnuts, cashews, almonds--probably 1 cup)
1 beer of your choosing. Moose Drool is nice. If the beer is too tasty, more of it will end up in your belly than in the soup...
salt and pepper to taste
cilantro to garnish

What would you do, if you knew you could not fail?

Facing the end of another week in which the in-box is not empty I think of this quote. I don't know the author. The words are printed on a wooden placard in LL's parents' house in PT.

It is Friday morning and I am making some pumpkin soup before heading in to work. In point of fact it will be a turban squash soup. And also, I will be finishing it when I get home after work. This will probably be the time at which I'll take the baked squash and blend it with the roasted red peppers and roasted tomatoes, and throw them into the pot where the garlic, ginger and hot peppers will be sauteing. Also I still have to buy the hot peppers. I'm hoping for habañeros.

Also, in looking for an enye (ñ) to copy and paste, I learned that habanero is actually spelled just like that, and that ñ is incorrect--and on the screen just below that, I learned that "octopi is ignorant in three languages simultaneously", as it is derived from Greek instead of Latin and thus would be octopodes (while in modern English octopuses is considered "correct"). Thanks Wikipedia!

But I digress. What would I do if I knew I could not fail?

Hopefully, I would still be doing exactly what I am doing now, which is to say, I'm about to turn off the oven and go into the hospital where one of my patients was just admitted and then go to clinic and finish some charts and make some phone calls and look up some information on how better to treat chronic pain and how better to diagnose chronic suffering and how better to encourage a healthy diet and regular exercise and nurturing relationships, which are the things that keep all of us out of the hospital, and all the while I hope to be learning, learning, learning, which of necessity requires some letting go of previously learned information and letting go of some long-held habits and prejudices and beliefs, not all once of course because that would be too easy, but perhaps bit by bit.

And maybe if I can keep working at this I can not fail. Maybe if I can slowly change, bit by bit, my self-expectations, I will not let myself down. Perhaps if I keep reaching out to others, asking for help where appropriate, which is really almost always, we will succeed.

Perhaps the question should be re-framed, to What would we do, knowing that we can not fail?

We have to go for it. As Andrea Gibson says, we have to create. Whether a jack-o-lantern or pumpkin soup, a patient care plan or meaningful relationships, this is what we are here for.

And then of course I look back at what I've written and realize it's too pithy. Too canned, too hokey, too much of this, not enough of that. I have failed. I think that now that my blog frequency has dropped off to near-zero, I am trying to squeeze too much metaphor into too little space, and the result is--well, to forge on anyway, it's a soup.

And at the same time, why not go for it? Most of us, as LL likes to say, are going to die. Most of us will start out looking like the pumpkin at the top, and slowly wither to become the pumpkin below. Why not make a soup of it? Why not do it anyway?

Perhaps the question is, If we know we are might fail anyway, what will we strive for?

The answer, I hope, is Yes.