Saturday, October 31, 2009

Class Act

Today, I was the member of a five-person team in a sailboat race on Lake Maumelle. I showed up early, having missed the "meet the crew" dinner the night before because Mike was on call and I was with the kids. It was chilly, and I was glad they were handing out gloves to the participants, but the last day in October promised to be one of the few wonderful ones. The sun was shining, finally.

Myself, my Uncle Chuck, and my Conway partner Amy were the three completely inexperienced participants benefiting from a donation made by my group to join two seasoned boaters in a morning and afternoon race. Our skipper, John Class, was originally from Holland, and had begun his boating experience in the 40's as a member of the Sea Scouts, an aquatic equivalent of our Boy Scouts in America. He participated in the Olympics in the 80's; missed out when we boycotted Moscow, but was sailing in California and Canada. He was clearly an esteemed member of the club, and assured Amy at the Friday dinner that he usually won the races. I found it difficult, upon meeting him, to imagine this boast: he was a man of few words, unless he was instructing us. He had a heavy Dutch accent, and his widely spaced teeth and sun-weathered, distinguished face gave the assurance of safety. We were in good hands.

When I agreed, three weeks earlier, to participate in the races, I imagined myself sitting on a sailboat in glorious weather like today, gazing at the water and trees, in a relaxed state of semi-participation, occasionally lending a hand and learning a little terminology. So I was just as surprised as my uncle and Amy, that it was constant work. And we were expected to be fully engaged. Not a bad thing - wonderful and rewarding, but shocking nonetheless.

There are numerous ropes, pulleys, and wenches on a sailboat, each with about six synonymous names, requiring repetitive releasing, pulling, and clenching, in order to race the boat. There are three sails: The main, the jib, and the spinnaker; the last needs hoisting and taking down. I used all my strength, pressed against the side of the boat, to pull ropes. But the funniest aspect of the whole experience, was the fact that Chuck, Amy and I knew nothing of boat anatomy. Whenever the skipper's language failed to generate action our part, he was frustratingly reduced to simple terms. "That black round thing! Over there! Now! Grab that rope! The one with the tiny green dots! No! Not the blue one! Hurry! Pull as hard as you can!"

The two races were each over an hour, briefly interrupted by a catered lunch. We thought, after the first race, we had the important parts down - the tucking and jibing (sp?), raising and lowering the spinnaker. But we were wrong. Problems arose on the second race - our spinnaker was stuck because we failed to release it from the front of the boat - we tried to release it from below the deck, and it got hung up on another sail. When we tried to pull the spinnaker in, it fell into the water, and we had to drag it out. Our speed suffered. We learned that the term for this was "shrimping." Not a complimentary term.

While all of this was happening, I imagined pulling our captain and his mate into the autopsy suite. With no knowledge of human anatomy, they would flounder. I would try to instruct them: "Now! Follow the stomach along the greater curvature down to the pyloric valve. The muscle is thicker there, you will need strong scissors!" As they cluelessly picked up the gallbladder, I might yell, "No! not the green bag, the beige one! The bigger sack! The one that looks like a leather water bottle! No! Don't cut that! Not yet! We haven't run the bowel yet! That will make a tremendous mess!" Or better yet - get them behind a microscope. "Now! Count the mitoses! That will determine how aggressive the cancer is. Count! We have to grade this cancer! NO! That is not a mitosis, that's an apoptotic cell! Here, it looks like this!"

That is what it was like - being thrust into a new situation with no prior knowledge on which to operate, and having to act quickly. But it was fun. And it was a glorious day. I learned how to watch the horizon, and steer the ship. I learned how to watch the water, to look at the color, in order to see an approaching wind. The water is darker, under a wind, and you can see it moving toward you and predict the precise moment it will fill your sails and affect your course. I learned to avoid the swing of the main sail when tucking, and how to wrap the ropes around a wench, clockwise. I am sure I am screwing up all this terminology, but having the experience inspired me to research it. Someday. After I get over the soreness and bumps and bruises, from the boat. Anyone who thinks sailing is a lazy sport, needs to go out and try it.

Friday, October 30, 2009

The Dancing Gorilla

I walked into Jack's classroom this morning, to help out at his Halloween party. Playing pass the Hot Pumpkin, freeze dance, helping with juice boxes and cupcakes - it was pure Dr. mom bliss. A nice ending to a week of volunteering at fall carnivals at the school and playing stay-at-home mom.

I showed up a half hour early - one of the teachers told me the time was nine-thirty instead of ten. I got to listen to another dad, a former UCA football player, regale the room with stories of his physical injuries retained during college. He listed them proudly: torn ligaments, broken ankles, broken ribs. At the end of his story, he was asked to read a book to the kids, and I was impressed at how he captured their attention and involved them in the book. I wouldn't have guessed that this overweight, bearded father, reliving his glory days with a classroom of four-year-olds, would be able to shift focus from his own accomplishments, but he did. Most of the children sat silently, enraptured, while I chatted with the teachers. Except for mine.

The teachers laughed while we were observing them. My son and the other Jack were silent, but their constantly shifting bodies, crawling around the legs of the chairs and the table-tops, were a sight to behold. The silently migrated towards the story-teller, occasionally interrupted by the teacher. "Jack. Back in your chair. Try to sit still."

"Is he like this at home?" They asked me. I replied, "Yes, it is tough to keep him in his seat at the dinner table. He seems to have an innate drive to climb on the counter tops, often resulting in mishaps. I thought all four-year-olds were like this, but now that you mention it, Sicily wasn't. His body is in constant motion. I chalked it up to a boy thing."

"Well, there are only two, in this class of twelve. Ironically, they are both named Jack. We are usually happy with their constant motion, as long as they are working, but we try to reign them in every once in a while. We tried to call them Jack S. and Jack H., but after saying Jack S. over and over, trying to keep him still, it started to sound, well, inappropriate."

I said Jack S. to myself, over and over in my head, and understood. I laughed out loud.

"So now we say Schneider and Halloway. It works better."

I marveled that I had been in the room for twenty minutes and was able to observe Jack, without being noticed. He had looked in my direction many times, but did not really see me. It reminded me of an unknown session at a pathology conference in Vancouver, a few years ago. The academic was showing unknown slides to a large audience, and occasionally flashed a dancing gorilla on the screen. The audience was so caught up in trying to figure out the answer, that when he asked, thirty minutes into the session, how many people had observed the dancing gorilla, only a small fraction of the audience raised their hands.

How could you miss a dancing gorilla?

It just goes to show, that even as an adult, you observe what you expect to see. When a room full of pathologists are concentrating on a projected view of an unknown slide, they are working so hard to find the answer, that important observations go unnoticed. And when your mother, who is not a normal presence in your school classroom, shows up to help, you can miss her, entirely, in the context of the situation.

He finally noticed. After I finished my duties, we danced. Then he asked me to take him with me on errands. I obliged, and we mailed the Halloween cards Sicily had made the night before to Uncle Mike and Aunt Effie. The we dropped of my favorite new children's book on the planet, Neil Gaiman's Blueberry Girl (warning: it will make you cry in the middle of Barnes & Noble), on a friend who just had a baby girl's front porch. She didn't even know I was dropping it off; we haven't really kept up. But we were friends in medical school, and I still have the pillow she embroidered for my daughter when I was pregnant. I hope she doesn't miss it - the book on the front porch. I hope I don't ever miss it. The dancing gorilla.

Tuesday, October 27, 2009

Thursday, 7:45 a.m., Conway Doctor's Lounge

I walked in with my coffee cup, behind an elderly gentleman in a white coat. The Conway doctor's lounge is less industrial than the one at the big hospital in Little Rock: cushioned chairs, flat-screen television, and did I mention the food? Cabinets, fully stocked refrigerator, counter tops overflowing. There is a cozy computer nook. A mustached, middle-aged man was sitting at a round table, eating a sausage biscuit. He remarked, "This guy is selling books. He's gonna sell a lot of books."

I assumed that his comments were directed towards the older man, since I knew neither of them. But the older gentleman marched resolutely into the men's room, seemingly oblivious to his remark. I walked over to the coffeepot, finding it difficult to resist societal decorum. I stared at the television. There was a post-college aged man, with blandly conventional good looks, discussing economics on the television. A broad band at the bottom of the screen advertised the title of his book, and a phone number. Curiously, at one corner, cursive script spelled the names "Denise" and "Sara." I decided reluctantly to engage. "Why do you think that guy is going to sell books?"

"Just wait. Wait a second and watch. You're gonna see in just a second."

As I poured my coffee, hoping I remembered correctly that the brown pot held caffeine, the camera shifted to two young blonds in skimpy outfits, large breasts spilling out of fluorescent yellow and blue spaghetti strap tops, solving the mystery of the cursive script on the screen. They stared open-mouthed at the aged frat-boy - seeming to yearn for knowledge. The doctor continued, "And these women are so stupid! He just explained to them that the government was giving away money for cars. And they didn't know! That was over a couple of months ago."

I silently questioned the women's stupidity. This was television. Probably scripted. Just because they were blond and big-breasted didn't mean they were stupid, and didn't know about Cash for Clunkers. They didn't seem any less intelligent than the guy peddling his wares. But who knows.

The doctor introduced himself. "I'm Kent Riley. Are you one of the new radiologists?" I told him I recognized his name from some of the surgical reports, and remembered talking to him on the phone. I explained that I was a pathologist rotating in Conway three or four days a month. I smiled and shook his hand, stating my name.

He said, "Can you believe this marketing? What they are doing these days? I just got out of a six thirty meeting. Do you know that these guys are grading us? The insurance companies, I mean. They are grading us. Unbelievable."

I was confused. "Do you mean grading as in our performance?"

"No! They look at Web M.D., and look at what people are searching. What the patients are curious about. And they grade us, according to how much money they can make from us. By looking at our specialty. Outrageous!"

I looked at the buxom blonds on the screen, and thought that plastic surgeons are probably graded pretty high. But I didn't bring this up. This was a professional atmosphere. I had just met this man. And we had already alluded to breasts, once. That was enough.

Instead I said, "Well, did you read that expose in the New York Times a couple of years ago? The one that talked about how drug companies were whisking off family doctors to large conferences, all expenses paid, and marketing anti-psychotics to women with depression? They showed videos of typically depressed women making typically depressed statements, and then resolution upon taking the drug. So millions of women were taking anti-psychotics, because they were complaining to their family doctors about feeling sad, lonely, and frustrated with life."

I remember reading that article, and thinking about my clients I worked with in college, at the home for schizophrenia. Many of whom suffered from extra-pyramidal symptoms, from first-generation antipsychotics. Restlessness. Resting hand tremors. Involuntary muscle spasms of the tongue, eyes, and mouth. I imagined a large body of small-town women, drooling and twitching uncontrollably while trying to make their kid's breakfast. A league of soccer-mom zombies. I realize that the second-generation antipsychotics have less side effects, and a couple of years ago, this is probably what was being pushed. But does this make the deception any less devious? Troubling? Downright wrong? I imagined the fat cats making the money, spending it gleefully and remorselessly. Drug companies, insurance companies, it's all the same.

So I told Dr. Riley, "I am no longer surprised, by what anyone will do for money." He stared at me, without comment.

I started for the door. He said, "Hey, it was nice to meet you."

I smiled. "You, too. See you around." It's always nice to put a face to a name.

Monday, October 26, 2009

Wedding Reception Recollections

Discussing the creepiness of a large baby doll, with a full head of golden curls, in an ancient pram, with John and his friend Annika. "Mommy, who is she? She's kinda scary." We were waiting for the cake to be cut.

Discussing molecular genetics with a plant geneticist, a researcher with a large crop of peaches and grapes. He failed to remember the tour he gave me seven years ago, when I flew with Mike, his dad, and a family friend to visit the experimental research station in small-town Arkansas.

Discussing philosophy and China with a student of my stepmother-in-law's (anthropology and education) and her boyfriend, who is pursuing his Ph.D. in philosophy. I had some intelligent things to say on the subject, thanks to my good friend Christie, whose husband is a philosopher. They recently spent a few months in China.

Learning of yet another witticism of my daughter, from an observation of a good friend, while unintentionally blocking the chocolate-covered strawberries, looming under a beautiful indoor gas-lamp, in the historic Arkansas home in downtown Little Rock. Why wasn't there any soot on the ceiling, I wondered? And when do you, as a parent, cease to take any responsibility of the keen observations of your offspring? From day one, I think. Sicily is in a league of her own.

Cutting a rug. Literally. I have not enjoyed myself on the dance floor so much since a family cruise to Jamaica at the end of medical school. One of the groomsmen, whose dance moves I couldn't help but admire, pulled me aside. "Your daughter is the best dancer here. Where did she learn it from?" I replied, "Well, we sing show tunes at breakfast, and play scenes from our favorite movies over and over, dancing and singing in the evenings, but I can't take credit for that." Eventually, she pulled me into it. After about an hour and a half, I overheard her saying, "Daddy! Where's my daddy? I really need a drink!" She was fortified with Sprite, and continued until the end of the night. Slept until after nine the next day. John went home early to bed with our nanny, but I hadn't the heart to pull Sicily out of her element. She was a sight to behold; I lamented later that she had me so caught up in her ecstasy that I failed to pull out the video camera. I'm hoping the photographer got some good pics.

The wedding was fabulous. I hope Annie and Dave are having a wonderful time in Napa. The kids were just squirrely enough, in their duties as ring bearer and flower girl, to be cute without ruining the wedding. John kept trying to engage me, and I deflected it to my nanny in the audience; after all, I was in charge of the bride's bouquet and the bridal train. I was trying to pay attention to the ceremony. John was disturbed that the fake ring tied to the pillow Annie had made had come free from its string tether. Josephina helped him put it back on, which he proudly announced to me in a loud whisper, during the ceremony. Later, my mother observed that his smile, during the ceremony, was diabolical. He was trying to orchestrate chaos, sweetly. This does not portend well for the future.

Friday, October 23, 2009

Wedding Toast

I met Annie when my husband Ike invited me to her graduation in Fayetteville, to meet his dad and stepmother. I remember my first conversation with her, in her high school bedroom. While she was fishing around in her closet for something to wear, she asked me how long Ike and I had been dating. I answered, a little embarrassed, “About two weeks.” She glanced at me, looked back in her closet, and announced knowingly, “Ike dates a lot of girls, but none of them ever last very long.”

That was over thirteen years ago. She has been my sister-in-law for the past twelve. Our relationship was primarily family-oriented for years; catching up and celebrating during the holidays and vacation. When she moved to Little Rock five years ago, we started to become close friends. I saw her more often, and even though I was busy in residency and having babies, she became a fixture in our household, joining us not only for important occasions but often just to hang out, have dinner, and chat. As my daughter grew older Annie started inviting her to sleepovers – they colored, watched movies, listened to music, and painted nails. I enjoy hearing Annie talk about the serious questions Sicily started asking her at three, and feel so lucky that Sicily has Annie to broach important topics with; someone outside of her parents, to get a broader worldview. Annie has fantastic answers.

Annie has many characteristics that make her a fabulous aunt, friend, daughter, sister, and soon-to-be wife: she is intelligent, adventuresome, petite, beautiful, stylish, loving, patient, calm, and has amazing taste in books, music, and gifts. Dave must be pretty smart too, because it didn’t take him long to figure this out. I remember a story she told me not long after they started dating: that she came home to a freshly cleaned house full of candles, flowers, and a gift from Box Turtle. She was breathless, smiling, and her blue eyes sparkled. At that moment, I knew tomorrow was inevitable.

Dave has joined many family dinners and celebrations over the past year, and he quickly won over the most important people in the family – the ones that can see people for who they really are, without all the social trappings of adult interaction: my children, John and Sicily. He shares job and recreation interests with my husband. We have met his family on many occasions, and they are truly wonderful. To Dave and Annie. They have made a big, important decision - to live the rest of their years, in this life, together. I look forward to supporting them, and wish them much happiness.

Wednesday, October 21, 2009

Star Student

That's what John is this week. Star Student. I imagine every kid gets this privilege at least once during the school year, but I had never heard of it. So when I came home from a full day of work on Saturday and saw the blank poster board with a stapled list of instructions (tape some pictures so we can hang it up in the classroom, bring a snack, come read a book to the class) I groaned inwardly - just what I needed - more to do on a busy call weekend as well as trying to wrap my work schedule around daytime school activities. The privilege for the child becomes the burden for the parent. I lamented to a girl friend on Saturday night, then chided myself for being so self-oriented.

So after a few hours of work Sunday morning, I met the kids at the tail end of a trip to the fair with Ike and his sister, and then took them home. Despite the fact that John was tired and whiny, being the vocal manifestation of my inward self, I cheerily dragged the poster board, along with hundreds of pictures from the junk cabinet, onto the carpet in the kitchen. Sicily was initially reluctant to be roped into a project where her brother was the sole focus, but her artistic nature quickly took over. While I was sorting pictures and arranging them neatly on the poster board, she ran over to the kitchen drawer to grab the scissors and started cutting them down to make a collage, which I thought was ingenious. I taught her the word. John wasn't into the cutting and taping, but he was loud about his picture preferences. We talked about them all - the pictures, how old he was, where we were, what we were doing. It was really fun.

Sicily wasn't happy with the blank spaces in the collage, but I told her that was where we were going to draw pictures, and there were enough spaces for her and for John, so I pulled out the crayons. John happily drew x's, punctuating each one's completion with a loud, "Checkmark!" He also drew some rudimentary faces, and of course snakes. Sicily followed his lead, trying to best him, but he was having too much fun to take notice. When it was all finished and we filled out the "What John Likes" worksheet, I was so proud I took a picture.

That night at bedtime, when I asked John what being Star Student meant for him at school, he happily replied, "I get to be line leader! And I get to sit down at the first computer!" His explanation was interspersed with hacking coughs, that had been steadily increasing and sounding worse throughout the evening. But I was so excited about the poster board, his role, my plan to read to the class on Tuesday, that I ignored them. When he crawled in our bed coughing at 3 a.m., I patted him back to sleep. But when he came into the bathroom while I was drying my hair at 6:00, teary and sniffling, saying "Mommy, I don't feel good," I decided I needed to find someone to stay home with him, and called for help. I got him some medicine and milk, tucked him on the couch in front of Tom and Jerry, and experienced irrational sadness that he would miss a day of being Star Student. I also got sad when I looked at the poster, knowing it would stay home after we worked so hard.

I whispered to John while he was watching TV, "John, do you want me to take the poster to school for you, or do you just want to bring it tomorrow?" He looked at me funny, and said, "Mommy, I'll just bring it to school when I get better." And I had to laugh at myself. Was that me, who wanted to bring the poster to school so bad that I was thinking of doing it without him? I imagined myself rolling through his carpool line, unrolling the window, and handing it over, "John is sick today, but here's his Star Student poster, we worked on it so hard!" What the heck was I going to do next, offer to stand in as line leader? Such a sharp, crazy contrast to the tired mom who didn't even want to do the project in the first place.

On Tuesday morning, Ike brought colorful Halloween cupcakes decorated with cat, bat and ghost rings, and I read one of my favorite children's books of all time, The Wildest Brother, by Cornelia Funke. I was delighted last spring to learn that she wrote YA books, and read Inkheart to Sicily over the summer. After it was over we watched the movie. I was so proud to realize what Sicily learned, at the young age of six, announcing during the movie, "Mom, the book is so much better than the movie! They are really missing a lot." I smiled and said to her, "That is true of all books, Sicily. There are a few rare exceptions, but books are almost always better than the movie." It was fun to bring the book to life, and we compared and contrasted how we had imagined the characters to what the movie had done to them.

Anyway, The Wildest Brother is amazing. I change the names from Anna and Ben to John and Sicily. It packs a wallop into a short venue - moldy green ghosts, wolves, bears, burglars, knights, slime-burping monsters, etc. The wild little brother imagines that he protects his older sister all day, sometimes annoying her, sometimes drawing her into his play, and other times playing along side her in a world of his own. But when dark falls (night's soot-black face) and creepy noises penetrate the house (the sound of a thousand biting beetles) John crawls into Sicily's bed and is thankful to have such a wonderful big sister. I managed to enthrall a bunch of four-year-old's, receiving enough hugs, introductions, and exclamations at the end to last a long time. Adoration from a room full of kids beats Chest Conference by a mile. So thank goodness for Star Student week, and for being pulled into art projects and my kid's classroom. I learned on my way out that Sicily will get to be a Star Student sometime this year, too. I can't wait. We've already got a giant Sicily collage going. Would you expect anything less, from her?

Saturday, October 17, 2009

Gross Anatomy 101

The new gross lab was sparkling and pristine. It was difficult to see the far end of the room from the double door entrance; a sea of fluorescent lights illuminated approximately forty stainless steel gurneys, each harboring a body covered in a long white sheet. They were arranged systematically, every table accompanied by a pedestal designed to hold a reference book. We were divided into groups of four - four people that would spend the next six months uncovering the mysteries of the human body. The first day was a religious experience.

As I wandered over to my assigned table, I thought of the first time I saw a dead body. My father’s best friend was killed in a hunting accident when I was around six years old. His name was Marshall, and I accompanied my parents to his Catholic wake. I remember silently studying his body, mistaking his respite for a state of slumber. I waited impatiently for him to wake up and play with us, as he did when he came over to our house to visit. I listened to adults covertly whispering, “He wasn't wearing an orange vest. Someone thought he was a deer. They sure covered up the bullet holes well,” and it began to dawn on me that he might not wake up.

There was also an open casket at my grandfather’s funeral. I was in high school at the time, and was pleasantly surprised to note, while receiving communion, that two of my best friends were in pews, near the back. It felt good to have support, because nine years later I better understood the concept of death. While I didn’t cry at the funeral, I remember driving around in my Oldsmobile Toronado convertible, music blaring, crying soundlessly over my family’s loss. As I walked past his body, I noticed his waxen features, and stared at the cake of make-up attempting to cover the pallor of death. I was no longer fooled, and looked away quickly, not wanting this image to replace the memories I had of him while he was alive.

As my three gross anatomy partners surrounded the body, I studied them. I recognized each, but had not worked with them in previous labs. Grady was the tallest – his boyish face thrust out eagerly under his ball cap. He looked no older than seventeen, and resembled a boy just off of the farm. His long gangly legs were covered in stone-walled jeans and his t-shirt advertised a bar from a Spring Break trip to Florida. His strong country twang, combined with his inability to stand still, cemented my first impression.

Jeff’s European air sharply contrasted Grady’s persona. He was shorter, and wore a broadly striped shirt and tight, dark jeans. His shock of dyed blond hair against his pale skin and sea blue eyes gave him a metro image, and I was surprised to learn he had a long-time girlfriend back home. He was quiet and nervous, not one likely to take the lead in this endeavor.

Amber was the last partner. A short, plump girl with heavy brown curls and a laid back personality, she seemed, at first, much more grounded than the two boys. Her pale skin was freckled and her easy smile was reassuring, falsely, I would eventually realize. But for now, I was comforted by her calm demeanor. She took charge immediately, pulling out her Netter atlas and placing it on the pedestal.

We started on the legs. Amber pulled aside the sheet, revealing skinny, mottled, wrinkled skin; definitely female. An elderly woman, judging by the yellowed toenails. The boys hung back as Amber and I wielded the scalpel and slowly began to dissect the skin off of the muscle. A task that seemed initially daunting became easily surmountable with our industrious activity. We were a team that day, Grady reading the dissection manual, Amber and I working on the body, while Jeff stood back and watched. We uncovered the requisite parts, each like a treasure - the popliteal artery, the sural nerve, the sartorius muscle.

The next day, Jeff didn’t show up. Grady, Amber and I plodded on, oblivious to a fact we would later learn: he had dropped out of medical school. I found it curious at the time that we, his gross room partners, were among the last to learn. Gossip encircled us like fog – “He was really stressed out, he wasn’t passing his classes, he was having problems with his girlfriend.” It was surprising to me that our anatomy teachers not only didn’t tell us he was gone, but he wasn’t replaced. We moved on unceremoniously to the pelvis. Now we were three.

Grady’s immature personality revealed itself slowly. He rarely picked up a dissection tool, preferring to read the manual. Even this task was not well performed – he attention often wandered to students at the surrounding tables. As I attempted to isolate the pundendal arteries and nerves, I remembered a story from a “meet and greet” med student picnic, one I had not attended. A girl friend of mine told me that Grady had spoken to every attractive female at the picnic, barely disguising his curiosity of their dating status. He remarked on one girl’s engagement ring, “I guess that means you are going to get married, right? So you aren’t available?” and another’s date – “So are you guys here together?” Every class is notorious for the women that use medical school as a vehicle to meet and marry a doctor, promptly dropping their noble goals when they have a ring on their finger. “Gold diggers,” to use a politically incorrect term. Grady was rumored to be the male version in our class.

Sure enough, on day three, Grady had not been at our table for three minutes before he announced, “I’m going over to Shelly’s table for a minute. I’ll be right back.” He was courting her. We did not see him for the rest of the semester. They married during our third year, and were soon rumored to be fighting loudly and publicly on their walk to clinicals from their Hillcrest rent house. They were divorced before we graduated.

But presently, they were in the thralls of new love. Amber and I missed our third partner more than the fourth, but we kept at it. Until one day two weeks into the semester, Amber called me the night before gross lab.

“Um, Gizabeth? I am not going to be there tomorrow. I think I have a virus. I’m really sick.” Her phone call was a courtesy, one that I was not to receive regularly for the rest of the semester. Her illness, however, was very regular. It happened every gross lab, for the rest of the year. Once, I bumped into her in the hallway. She seemed well – and looked guilty at my quiet appraisal of her health. She stopped me and invited me to play Scrabble and Monopoly with a group of students at her house that Thursday night. I was sickened that she couldn’t support me in gross lab, but could host board games on school nights. I declined politely, and ignored her pointedly for the rest of med school, most noticeably when we were in line to graduate together, in Barton Coliseum.

The first day I was alone at the gross table, my neighbors remarked, “Gizabeth, where are your partners? What are you doing there all by yourself?” But I quickly became an accustomed anomaly, one that was ignored by the anatomy professors, and my classmates followed suit. I remember watching my friend Kay jealously – had I not taken my married name I would be alongside her and her partners in the “N’s” – she reading the gross manual as her three partners dissected the body. Many of my classmates still meet yearly with their gross partners – dissecting your first dead body is a bond not easily broken by the passage of time – but having partners was a luxury that was not afforded to me.

In residency, when I performed autopsies, after the diener eviscerated the body, I was often alone. It is easier to be alone with a body when there are not forty groups of four people around you, tackling their bodies as a team. Strange, how being isolated is less isolating when you are by yourself. I wonder what Amber, Jeff, and Grady are doing now. I don’t wish to be reunited with them; there aren’t really any remembered moments over which to bond. But I don’t hold any grudges against them, and I hope they are happy and fulfilled in whatever fields they chose to pursue.

Friday, October 16, 2009

Showing Off

My new ability to embed HTML (thanks Gasper!).

Isn't that fancy? I've been listening to this song all week in the car. Weird to put it to video -- all submarines and spotty leopard sharks. Not at all what I was imagining driving to work and back. But I still love this song.

Spotty Dangerous II

I am embarrassed to tell this story, but feel the need to confess. I'm on call tomorrow and the marrows, spleens, and lymph nodes are rolling in. By my own warped law of averages, I deserve a break tomorrow, since my last call was a doozy. But it doesn't seem I am going to get one. I believe it is my punishment, and I accept it without complaint.

Tuesday morning Ike called me.

"Spotty's gone."

"Gone, what do you mean?" I asked calmly. I was thinking back to the last time I saw Spotty, on Saturday, and I know Ike fed him on Sunday. I guiltily remembered seeing the top to the reptile aquarium slightly ajar on Sunday. When I tried to replace it, I had trouble, and worried I would break it. I made a mental note to ask Ike to fix it, one that got lost in the flurry of post-its in my brain.

"I can't find him. He must have escaped."

Ike must have anticipated an angrier reaction from me, because he was armed with internet knowledge.

"I read that corn snakes can live without food, in a house, for six months to a year. And if they escape into the wild, they are home free. I think he will be OK."

I replied, "Well, I really don't think we are going to find him. Why don't you just buy another one? It's not like he's a dog, and we haven't had him that long. The kids will never know the difference."

When I said that, I was thinking of all the little things that already disturbed a good night's sleep, in our household. Nightmares - Sicily has been having more of them lately, especially at the beginning of her sleep. And John has yet to shed his habit of sneaking into our bed between 3:00 and 5:00 in the morning, which sometimes turns my early a.m. run and our getting ready time before the kids wake up into chaos. I imagined their thoughts of a loose snake in the house -- one that Sicily is comfortable with as long as an adult is with her when she holds him, and one that John still doesn't want to hold by himself -- would initiate a new round of nocturnal bedlam I hadn't seen the likes of since John was still up nursing three or four times a night. The thought of it made my stomach turn.

As soon as the words came out of my mouth, I wanted to retract them. I remembered all of the stories I had read as a child, where the parents tried to pass off a replacement for a favorite doll or a pet to their children. In the stories, the parents were the evil villains. The kids always figured it out in the end, and the parents took a big fall off of their pedestal. So when Ike replied,

"I don't think we should lie to the kids. I'll tell them about it tonight," I didn't protest. I told him that was the right thing to do.

After the kids went to bed Tuesday night, I asked Ike, "How did it go? Did you tell them?"

He said, "The more I thought about it, I just couldn't. I decided I'll buy another one tomorrow, like you said, and we can just see what happens."

So Wednesday night when the kids went to see Spotty, they remarked at his transformation. Sicily said, "He is so much darker! His spots are whiter! He looks so different!"

Ike guiltily replied, "He finally shed! I cleaned his skin out of the cage today. Isn't it amazing how different a snake looks when it sheds its skin?"

When Sicily asked to hold him, she noted, "He is so much thinner! He must have lost a whole lotta skin."

Needless to say, we passed it off. I feel shameful, but am glad that there isn't another excuse for not sleeping in the house. Here I sit, the evil villain of my childhood stories. I'm on the other side now, and can finally see it from the parental perspective. Not that that makes it right, but still. Someday I will confess to the ones that matter - the kids. In the meantime, I will suffer my call silently and deservedly, however warped my reasoning for the heavy workload is.

Tuesday, October 13, 2009

That Moment

Everyone has one. The moment where you feel like your sanity has finally reached it's peak and from here on out, it will be a downhill slide. Or you've decided you have turned into your mother. Both equivocal sensations.

I was on the way to school this morning with the kids and was pleased that they were in good spirits. It had been a mediocre morning - a little whining from John, who woke up too early, threatened to disturb the mood equilibrium but we all managed to get out the door with food in our bellies and eyes dry. Except when we stepped out into the continuing Arkansas monsoon; then we got wet all over.

Sicily started spelling Mississippi over and over, the old sing-song way, with crooked letters and humpbacks, ironically, I noticed, right as I pulled onto the street. John began to imitate, "M-I-S-S-M-I-S-S-P-P-P-P-I." Sicily became enraged, and kept trying to correct him. I had to rush to his defense - looking at her in the rear-view mirror and pleading quietly "Zip it, Miss C. He's just trying to imitate you, and it doesn't matter if it's not right. He's having fun." But if you have kids, you know that reasonable pleading cannot contain an older sister's need for being right, so she showed him a street sign as we rounded the corner and said, "See John! I'm right. Mississippi. There it is," to the oblivious John, who is still learning to recognize and write all of his letters.

In the carpool line, the conversation quickly turned to how many times (1) they are allowed to have fast food a week, with Sicily pushing limits and twisting words to attempt to increase the number. Then she started reminding me loudly and repetitively to tell her teacher, who is luckily on carpool duty this week, that I was the one who cleaned out her backpack and threw away the blank sheet of paper that she was supposed to copy her spelling words on last night. My accidental over-cleaning initiated much anxiety on her part, with an ensuing multi-store search for the elusive "B Tablet." Sicily finally settled on similar paper, but worried all evening about the different colored lines and the lack of a margin for numbers, which she eventually decided to draw herself, disconsolately.

So I told the teacher of my error, childishly giving Sicily an "I told you so" look when the teacher said it didn't matter at all. She shut the door, and I simultaneously sighed with relief and cranked up Grizzly Bear, happy to be on my way to work. As I was heading down Mississippi toward Markham, I heard a little voice in the backseat, that almost made me jump out of my skin.

"Mommy? Where am I going? What is happening?"

I usually drop John off at the second stop, right after Sicily, but she had been so loud for the last ten minutes of the car ride, and John had been so quiet, that I just sailed past, forgetting about him entirely. Even though I knew I had already been through the magic carpool window between 7:30 and 8:00, the one that took me a few weeks to find, where you only have to sit in line for 5 minutes instead of 15 or 20, I couldn't help laughing. Apologizing to John. Turning around, resigning to the fact I would now be thirty minutes late to work and there was no one to blame but myself. Wondering if this was the beginning of the end.

Saturday, October 10, 2009


This past week, I was approved to sell some days to a part-time partner so I could go to San Francisco in mid-November. I am on Cloud 9. I lost the opportunity to get the dates honestly in a vacation Russian Roulette - who knew that mid-November would be swept up in the first two rounds? So I begged and begged, and in the end, everyone is happy. Especially the partner I am paying to work for me.

I picked out this conference months ago - an oncology conference set in the historic Palace Hotel in downtown San Francisco. Last year, when I went to Monterey, I was on an isolated resort and was so relieved to have some time away from family obligations that I just ate in the resort hotel every night and retired to my room. And watched Obama win the election. And started my blog.

This year, I may not pay the exorbitant internet hotel fees, because before I even booked my plane dates or registered for the conference, I booked a night tour to Alcatraz. Recently, one of my good friends in the gross room went to New York City by herself - she saw plays, went sightseeing, crossed the Brooklyn Bridge. While she was on the Bridge, she saw a wedding party getting pictures taken. She was amazed, and wondered how they got there. She decided to ask a high-heeled, hot-pink satin clad bridesmaid.

"How did you all get here for pictures?"

The beautiful girl, who I saw in her trip pictures, answered loudly: "We Foo-kin walked! Can you believe that shee-it?"

So I was inspired, by her. Go to a big city by yourself, and instead of hole up in the hotel at night, see the sights.

I hear the night tour of Alcatraz is amazing. I will take a ferry to the island, watch the sunset, and listen to an audio tour of the prison after dark. Fitting, since among others, two of the books I have read in the past month are Monster, by Walter Dean Myers, which I picked up last spring at B&N and finally got around to reading, and Sleep Toward Heaven, by Amanda Eyre Ward - a great book about a doctor, a widow, and a woman on death row, that my mom gave me for my birthday. Monster won a lot of book awards, and I am glad to have read it, to pass along to my son when he is a teenager. Both books highlight the precarious lifeline between ourselves and those that end up in prison, even on death row. Circumstance, and life experience, can turn the tables in an instant.

I also learned that Wicked is playing at the Orpheum in San Francisco, from one of my partners. Again, I'm over the moon. A great musical that I haven't seen, and I read the book last spring. I called my pathologist friend that works at Stanford, and even though she may not make it to the musical, since she has a new baby and is still nursing, she is trying to coordinate a night to come to dinner with me in the city. My foodie brother, who ate at Alice Water's restaurant Chez Panisse last week (I'm so jealous!), is helping me find some great restaurants to get reservations.

When I booked my night tour, I worried, because I will be missing about two hours of the conference. Not typical schoolgirl behavior - but what the hell. You only live once.

Wednesday, October 7, 2009

A Lost Art

I was at a housewarming party for one of my partners last Saturday night. The contrast between her persona at work and her home is striking. In the lab, she is lighting fast and efficient, attacking her cases and frozens like a sleek tiger. Her home is soft and Victorian; wood floors, marble posts, tasseled curtains, and walls covered in Da Vinci and Degas, framed in ornamental gold.

I was leaning on the granite counter tops eating smoked gouda and brie, talking with two of the gross room techs. The older one has worked in the gross room on and off for thirty years, and was remembering the time when there was at least one autopsy per day, back in the early eighties. By the late nineties, he said the numbers had dropped by 2/3rds. We now average four or five autopsies a year. I have been at my hospital for over two years, and I have performed only one. A stark contrast to the almost 100 I did during my residency training.

I wondered the reasons for the decline in the autopsy, and started asking opinions. I have my own hypothesis: that imaging techniques have become so advanced in the last thirty years that there is no reason to perform an autopsy - I already learned from my training that new information is rarely revealed. Although that is certainly a factor, conversation with other partners uncovered more contributions to the death of the necropsy - no pun intended. Autopsies are very time consuming and there is little reimbursement from medicare and medicaid. If someone dies outside of the hospital, the autopsy is not covered, and when a family member learns that they will have to foot a $1000 to $3000 bill on their own, depending on the state, for a private autopsy, the desire for the procedure quickly wanes. And if you really think about it, do you want your pathologist, who usually works for the hospital, rooting around looking for things that the clinician missed, so that they can be implicated in a lawsuit? Not really, although truth be told, as I said before, radiology and serum lab tests often trump surprise findings at an autopsy.

I was trolling around on my serious path blogs today, and came across on that discussed the virtual autopsy. It is fascinating:

Of course, one place where the autopsy is still very valuable, is the crime lab, where most of path residents get their "autopsy numbers" in order to sit for boards. But I imagine this new technology might bring the autopsy back, if necessary, to gain additional information that may not be easily accessible by traditional methods.

In a way, this makes me a little sad - an old dinosaur eschewing new technology, that may someday replace a time-honored tradition. A tradition that involves more than just the eye - the autopsy engages olfactory, tactile, and visual senses, which all also come to play in the gross room. Even though I still get to examine organs in the gross room, I miss the autopsy. After the diener eviscerates the body, the pathologist is left alone with the block of organs: trachea to internal genitalia and everything in between, tracing pathways and organs to search for the root of the problem, which has often already been determined prior to death, and is merely, in this day and age, an academic exercise.

Sunday, October 4, 2009


Maybe sparrow you should wait
The hawks alight till morning
You'll never pass beyond the gate
If you don't hear my warning

Notes are hung so effortless
With the rise and fall of sparrow's breast
It's a drowning dive and back to the chorus

La di da di da di da
La di da di da di da

Oh my sparrow it's too late
Your body limp beneath my feet
Your dusty eyes cold as clay
You didn't hear my warning

Maybe sparrow it's too late
Moonlight glanced off metal wings
In a thunderstorm above the clouds
The engine hums a sparrow's phrase
For those who cannot hear the words
For those who cannot hear the words
For those who will not hear the words

La di da di da di da
La di da di da di da

Maybe sparrow
Maybe sparrow

This is one of Sicily's favorite Neko Case songs. We sang it over and over at bedtime, until she got the words and melody down. I love singing with her, explaining the lyrics. Sometimes I worry that her thirst for knowledge outweighs her six-year-old brain and I try to gauge my teaching accordingly. I want her to understand metaphors and interpretation, and the beauty of language.

She told me last week that her piano teacher told her she sings beautifully. And I was so proud, because she does. I remember her long, warbling, melody-less tunes she used to entertain the family with at two and three, and marvel at her development since that time. We work on it every night.

Lately, we have gravitated back towards musicals. We have been singing Annie. The other night, she was directing, and wanted me to sing with her.

"Mom, you sing this, then I'll sing this, then you and I sing together. Like this."

"So you want do do a duet?"

She was confused. "What mom? Do what? Do it? What do you mean?"

I answered, "You want to do a duet, Sicily. Sing a duet."

She was louder. "Do what? Do it? What are you talking about?"

I laughed at her Laurel and Hardy-like take on what I was trying to say. "Do you know what a duet is?"

I explained it to her. "Yes mom! That is exactly what I want us to do."

So we have been singing duets, lately. Sometimes she lets her American Girl doll, Sara Amber, chime in. She gives the doll space for the lyric, and jumps ahead as if the doll was really singing it. She directs me. It's funny. And wonderful.

Saturday, October 3, 2009

The Planets are Aligned

My best friend from medical school sent me this e-mail last night. She doesn't e-mail more than once every month or so, but when she does she gives me a lot to think about.

I was watching the show criminal minds tonight and it ended with this quote that I immediately googled.

G. K. Chesterton - Fairy tales do not tell children the dragons exist. Children already know that dragons exist. Fairy tales tell children the dragons can be killed.

And then I found this complimentary quote:

C.S. Lewis on why he preferred fairy tales to “realism”:

“By confining your child to blameless stories of child life in which nothing at all alarming ever happened, you would fail to banish the terrors, and would succeed in banishing all that can ennoble them or make them endurable. For in the fairy tales, side by side with the terrible figures, we find the immemorial comforters and protectors, the radiant ones; and the terrible figures are not merely terrible, but sublime. It would be nice if no little boy in bed, hearing or thinking he hears, a sound, were ever at all frightened. But if he is going to be frightened, I think it better that he should think of giants and dragons than merely of burglars. And I think St. George, or any bright champion in armour, is a better comfort than the idea of police.”
– “On Three Ways of Writing for Children”

If I had a blog I would be blogging about this quote right now. Consider yourself my one blog reader for tonight. :)


Strangely, my blog name was inspired by a quote I like by G.K. Chesterson. I'm going to have to find out more about this guy.

"He may be mad, but there is method in his madness. There nearly always is method in madness. It's what drives men mad, being methodical."

I was at Barnes & Noble the night before she sent me this e-mail loading up on new books for Sicily and bought one by C.S. Lewis.

Speaking of planet alignment, they must be really working in my favor right now. All week long, my kids have been fighting over cooking our eggs for breakfast! One morning John, one Sicily. I had to alternate, because the two of them trying to do it together was a recipe for disaster -- no pun intended. In a way, it challenges my a.m. order, in terms of efficiency, but that's what kids are good for, right? To shake up our notions of order and method, and create something new. Often better.