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Medical Humanities Section Newsletter - August 2009, Vol. 5, #2

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circle_arrow From the Editor
circle_arrow From the Chair
circle_arrow Pizza In A Blender
circle_arrow Argiope Aurantia at Niagara Falls
circle_arrow Mean Streets of the Universe
circle_arrow Captured Sun
circle_arrow If Life Were Fair
circle_arrow In Or Out
circle_arrow Breakfast for Champions
circle_arrow Early Summer Evening – Keuka Lake, New York
circle_arrow Going Home
circle_arrow Sunset - Keuka Lake, New York


Newsletter Index


Medical Humanities Section

 

MUSE – Summer 2009

From the Editor

From the Editor
Peter J. Paganussi, MD, FACEP
Sibley Memorial Hospital
Washington, DC

There is something very comforting to me about sitting on a porch, sipping lemonade or ice tea, and watching fireflies crookedly careen across a lush green background. This speaks summer loudly to me. I spent most of my childhood summers in the Hudson Valley region of New York State, largely in the Rockwellian hamlet of Millbrook, N.Y. It can be hot and steamy in this part of the country, always with a hint of a haze towards the horizon. But the evenings often cool off nicely and provide a gentle breeze. I would often sit with my grandparents, on their front porch, and do just what I described. It is no wonder that I look forward to this as amongst my favorite summertime activities. 

I love the way life, even in today’s hurry up,"instant text message" world, seems to slow down just a bit. In that spirit I am delighted to present you with the 2009 Summer issue of MUSE. As always I had huge fun putting it together. Once again, I am pleased to be able to present to you the works of some of our very talented members. My recommendation is to slow down, grab a tall cold drink, go find a nice little nook and enjoy this blast of summer from the Section of Medical Humanities. Normally, at this juncture, I would take the time to summarize the forthcoming works by way of introduction. The following works are so good and so bursting with summer that I think I will politely largely refrain and let them speak for themselves. 

Briefly, the lead-in is from our section chair, Dr. Hans House. This is followed by Dr. Ron Iverson’s "Pizza in a Blender." We are then treated to a visually stunning photograph from Dr. Kathryn Hall-Boyer. Equally beautiful photographs and a delightful poem, "Mean Streets of the Universe," come from Dr. Frank Edwards, who lives and works in Upstate NY, not terribly far from the Hudson Valley. Dr. Gary Morneau has provided us a visual feast with two of his paintings. Dr. Shay Bintliff from Hawaii (aloha, from a place where it is mostly summer all year round) treats us to a poem from her book "Soular Energy." From the perpetually sunny state of California Dr. Jay Kaplan presents us with another one of his splendid poems. And finally, a piece from yours truly about a recent early summer experience.  

Stay cool, grab a tall "cold one," and enjoy the coming summer feast for, eye, mind and soul. Oh, and watch the fireflies…they never seem to be in a hurry. 


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From the Chair

Hans House, MD, FACEP
University of Iowa, Iowa City, Iowa


I got an email the other day from Pete Paganussi, our beloved newsletter editor. He happily announced that he had assembled another crate-load of material for the summer newsletter. All he needed to finish it was . . . something from me (oops). Pete was very understanding in his gentle missive of my procrastination, saying, "I know how busy July can be for a program director."

How true.

When people ask me what are my plans for the summer, expecting to hear about backpacking in Yellowstone National Park or biking through Italy, I bluntly reply, "Running around the hospital trying to keep my interns from killing someone."

There has to be some moment when the medical students of last year start being the physicians of this year. Traditionally, that moment has been the first call night of July 1st. Fortunately for patients, we recognize this and have instituted different start dates among our inpatient call specialties to maximize overlap between the new interns and the departing seniors. But the dark joke about newbies running with trauma scissors remains: don't get sick in July.

In our emergency medicine program, we go one step further in transitioning our graduating students into "real doctors." We spend the whole month of July in an intense, comprehensive life saving course. We cover everything from the difficult airway and acute MIs to breaking bad news to patients and wellness in emergency medicine. Then, we turn them loose on August 1st.

So, don't get sick August 1st.

But despite my pessimism, the residents do just fine. In fact, I am constantly amazed by the enthusiasm, dedication, and simple joy they get from caring for every patient they meet. Here they are, after 4 years of medical school, dozens of residency interviews, thousands of airline miles, and one agonizing match day, and they have finally arrived at the beginning of their emergency medicine career. Every time I see the passion in their eyes at the start of a shift I am reminded of my own early days. When I witness the thrill they get from draining their first stinky abscess I know why I decided to teach emergency medicine. And every time I sit down with my interns at the end of a shift, sharing a coffee over a huge stack of charts, I still smile, knowing that I really love this job and I couldn't do anything else.

I hope we can bottle a fraction of my intern's enthusiasm in our section officers, to be selected at this year's Scientific Assembly. See you in Boston in October!  


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Pizza In A Blender

Ron Iverson, MD, FACEP

 In my childhood, I thought that the real world was represented by the ideal in "Leave It to Beaver." In this world, good and evil were clear cut. White and black were distinct. But the world I found myself in lacked such clear distinctions. The world I lived in was not so stable. It was, however, far more nuanced and far richer in texture and color. It had not two colors, but thousands. I discovered that I wanted not to live in the orderly world of "Leave It to Beaver" but in this other, less ordered world. Rather than living in a ticky-tacky stable "Leave It to Beaver" world, I lived in a world that more closely resembled a Pizza in a Blender. 

I seek chaos. I find my comfort zone in manageable chaos. 

Yesterday was a day of chaos. The crush of sick and injured patients truly taxed me. The elderly with indistinct but frightening shortness of breath, the younger patient with chest pain. The potential hidden pneumonia, cardiac event or pulmonary embolus. The abdominal pain that seems mild caused by life-threatening disease, the neurologic symptoms seemingly deadly caused by neurosis, the child hit in the head with a sled who stopped breathing and we thought to be dead. The cut fingers, colds, the pregnant worried, the leaking aneurysm, the patient who no longer wants to be alive but for the grace of God cannot seem to die. The patient who waits patiently for the test results that were forgotten. The patient who is angry that he has not been seen immediately for his chronic illness. The worried mother. They keep coming in. I can no longer keep the patients straight, nor can the staff. They get lost, I get task-saturated, and we teeter in the edge of collapsing in a morass of medical error. Too many patients, not enough resources–physical, personal or cerebral. No place to put the nice guy who may be having a heart attack. No mental capacity to care for him. 

After fourteen hours, I come home exhausted. It is late, and I have to get to sleep. But the three-year-old Arianna is dragging her new toys up the stairs, patiently and determined. She is determined for one reason: she wants to show her Opa what Santa brought her for Christmas. All the way up the stairs: three baby dolls, one in a tiny crib, one in a tiny swing, one in a tiny buggy. Clump, clump, clump, clump. She has her big grin, shows me how one baby cries if you push a button. She tells me about her babies. She sits on the couch and holds my hand for a few minutes. She likes physical contact. I find I enjoy it also. But she does not sit still for long. That is not her nature. 

I awake at 0140 in the morning. I remember that I forgot a patient. I hope someone remembered her and finished her case. A casualty of the chaos I live in. I think about chaos and how it differs from the orderly world of "Leave It to Beaver." I think about Arianna, repeatedly lining up her toys in a nice orderly manner, and I realize that we share something. Arianna and I both seek to create order out of seeming chaos. This gives us comfort. It is what I do for a living. It is what she does as a child. I realize that I enjoy taking a crush of patients and diagnosing a pulmonary embolus here, sepsis there, anxiety in another patient. I alleviate pain and anxiety. I create orderly charts, satisfied and educated patients, and an endless flow of preliminary treatment plans. I create "thank you’s" and expressions of gratitude. This I make out of chaos. This is what I do. 

I see myself as an artist. So is Arianna. We both create masterpieces--from chaos resembling Pizza in a Blender. 


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Argiope Aurantia at Niagara Falls

 

Argiope_Aurantia.jpg
Kathryn Hall- Boyer, MD, FACEP
Emory University, Atlanta, Georgia

  


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Mean Streets of the Universe

Frank Edwards, MD, FACEP

Our eight year old came home one day
Talking of orbits and the speed of light,
And how the earth makes day and dark
By spinning on its ass kick.

Arrogant blue-green Earth
Strutting up there so fat and pompous,
Who are you to yank around the moon?
Who are you to call the shots?

You with your spindly clouds and beaches,
Your molten innards piddling forth and bubbling
Your clots of space junk and little scrim of gas—
You suck up to the sun like all the rest.

And Fusion man’s the real bad ass up here.
Just ask that little wack-job Mercury,
Racing around with his butt on fire.
Earth—you can kiss the moon’s ass! 

She may be just a torn-off chunk of terra,
Collision chiseled, airless and pockmarked,
But she damn well knows that Earth is overdue:
Another major ass whump’s on the way.

Here comes that asteroid baby
Like a big chopped Harley raging down,
And Luna grinning cockeyed
From the best seat in town. 


 

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Captured Sun

 

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 Gary Morneau, MD, FACEP

  


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If Life Were Fair

(From the book Soular Energy)
Shay Bintliff, MD, FACEP

If life were fair,
 would we awaken each day with
 Joy
 love
 Compassion
For all who bring conflict and pain?

 If life were fair
 would we reach out for those
 in need
 displaced
 almost erased
From the human species?

 If life were fair
 would children suffer the pain of
 abuse
 neglect
 untimely death
With no notion of "why me"?

 If life were fair
 would we be willing to fight
 prejudice
 greed
 hate
Knowing it must begin with me?

 If life were fair
 could we visualize a world with
 tranquility
 harmony
 peace
Because we each created it!


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In Or Out

 

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Gary Morneau, MD, FACEP

 


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Breakfast for Champions

Jay Kaplan, MD, FACEP

this morning

    a question 

do I foray into the world
            or
do I stay home

            risk exposure
             or
            feel secure
                       test my capabilities
             or
                        count my blessings

it is sunrise
             and
 the darkness of the night is slow to give way to the dawn 

where are the answers 

I need the light to teach
 and touch
 and warm
my fear
 doubt
 confusion 

the question becomes
 how can I feel most alive 

searching
 I begin to see the hazy outlines 

fear drags me into the past
 or propels me into the future
 while in the present moment
 I am offered many treasures 

there
 here
 I connect to people
their present
 feelings
thoughts
 hopes
 dreams
needs
 wants
 desires
and they to me
 and mine 

gifts are given

intimacies shared 

frightened
 I wish to escape
no
 no 

I do not have permission to leave the table
 and I am still hungry 

the feast is ever present 
 for those willing to sit at the table and partake 

is this not what we most crave 

what do we serve at our table
 when people come to us for care 

do we invite them to sit
 and do we sit with them 

do we hold hands as we begin
 or do we start with the forks and knives 
 and needles and pokes immediately 

do we offer them nourishment
 or simply food 

at the end of the meal do we feel satisfied
 and fulfilled and grateful
 or just no longer hungry 

do we all feel healed 

I want my days to be filled with feasts
            for my patients
            for my colleagues
            for my self 

it is no longer dark outside
                        or inside 

let us all sit

let us all walk

let us all care

let us all feast 


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Early Summer Evening – Keuka Lake, New York

 

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Frank Edwards, MD, FACEP

 


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Going Home

Peter J. Paganussi MD, FACEP
Sibley Memorial Hospital - Washington, DC

We shall not cease from exploration
And the end of all exploring
Will be to arrive where we started
And know the place for the first time.
- T.S. Eliot

In his largely autobiographical novel "Death in the Family" James Agee lays out events that occurred in 1915 when his father went out of town to see his own father, who had a heart attack. He was then killed in a car accident during the return trip. The novel provides a portrait of life in Knoxville, Tennessee, detailing how this tragic loss affected his mother the young widow, her two children, her atheistic father and the dead man’s alcoholic brother. It won a Pulitzer Prize for Fiction in 1958, posthumously, for Agee who died while writing it in 1955. In the pages of this book are contained a quote that is both well known and often used. Like so many quoted phrases most people who refer to it don’t actually know its origin. "You can never go home again" is Agee’s oft-quoted line from the book. The full quote is actually, "How far we all come. How far we all come away from ourselves. You can never go home again." 

In the context of this story most would interpret the author’s meaning as once you grow up and have your own life, even if you physically return to your childhood house, you can't return to that place of innocence and safety -- it's never "home" as it once was because you are in fact a different person. If this was Agee’s meaning than I would respectfully submit that he was wrong. You can go home again. I would concede that for the most part Agee’s assessment was accurate. I have been home on many an occasion when I was disappointed that things had changed, and that I had changed. Everything looked smaller and seemed more dilapidated than I remembered. I knew that I was looking at the same place through a different set of eyes. My adult sensibilities, life experiences and educational pursuits were clearly coloring my perceptions of "home." However, all that changed on my last visit home just last week.            

When we use the quote, I think all would agree that this generally refers to the home of one’s youth, the home you occupied as a child and adolescent. I currently live in Oakton, Virginia and have for the past 15 years. I have lived in Northern Virginia, in the Washington, D.C. suburbs, for the past 20-plus years. So Virginia is clearly my home. It is my current place of residence. My wife and I have raised our three children here, so this is most definitely my home. Yet, my "home" is the house where I grew up and is located in the Bronx, New York. My parents still live in the very same house that we moved into way back when I was in the fifth grade, in the spring of 1970. I had returned home for my father’s surgery. It was a long anticipated event for him and naturally he was concerned. He wanted not just his son there, but his son the doctor who moves easily in the world of modern medicine. It is a world that can be very mystifying to the uninitiated. In fact it can actually be even more mystifying for the indoctrinated, but this is a whole other topic. 

Suffice it to say that things went as well as possible and my father has been making a swift and thorough recovery. While I was home, my younger sister flew in from her home in London to also be there for Dad. It was really great getting to spend time with all of them despite the circumstances. We have always found a way to make each other laugh in our house and that has certainly not changed. We laughed as we recalled family members, some long gone, who were an integral part of our formative years. We mostly cherished the time we were spending together, even when it became strained. It seemed like we all know that as we age these times together become increasingly precious. It was unspoken, but I got the sense that all of us felt that way. Somehow, sitting around the kitchen table again, it was as if time had indeed reversed itself and we were back where we started. It was a very gratifying feeling to be sitting across from my mother, father and sister like we did so many years ago. It evoked only good memories and it was as if I were outside it all and looking in on the moment. It would have been a fantastic trip, in and of itself, if it were for just these family moments, and of course the success of my father’s surgery. But something else happened on my trip, something largely unexpected. It was something that became utterly magical. 

As a boy I attended a Roman Catholic parochial school called Our Lady of Solace located on Morris Park Avenue in the Northeast Bronx. It was across the street, and associated with, a church of the same name. In the 1960s and into the early part of the 1970s it was a vibrant and bustling place. It was the focal point of my neighborhood. My class had 44 students and most of us went through all the grade levels together. I left the school in 1972 after completing the 7th grade. I did a summer program at Fordham Preparatory School that allowed me to begin high school immediately. So I left what would be the OLS Class of 1973 a year early. That year, 1973, would be the last time I laid eyes on many of my classmates. Over the ensuing 5-6 years I would occasionally see one of them at church, but mostly we all were scattered to different high schools, then colleges and ultimately jobs. Many of us moved away from the "old neighborhood" and we simply lost touch. Over the years I have often wondered about many of these "kids" that I went to elementary school with: where were they and what had become of them? 

I guess I was not the only one with these questions. Through the amazing power of the Internet, over the last 6-8 months, a number of us have reconnected. Since I knew I was going home, I e-mailed a few of them and gave them my cell number. On Friday evening, June 19th, a group of 5 got together again. After some 30-35 years apart, we would be in the same room again. It all fell together very quickly and without much fuss. We decided to meet at an Italian restaurant in our old neighborhood, not far from where my parents currently live. 

Bill ("Billy") J, Gary G, Frank B, Joanne M-N and Peter P met at Frankie & Johnny’s Pine Tavern, on Bronxdale Avenue for an impromptu reunion. It stands as the only reunion of its kind for the OLS Class of 1973. The magic in the air was palpable. I walked in a few minutes after the others arrived. I found them sharing drinks around the bar. I wondered as I arrived if I would recognize them, and if they would be able to pick me out of a crowd. I spotted them instantly and they all turned and smiled knowingly at me. I didn’t see 50-year-olds, I saw the children that they were all those years ago. Looking into their smiling, nay beaming, faces it was as if I were looking back into time…my time…our time.  

We had entered some sort of Einsteinian wormhole that transported us all back to the late 60s/early 70s, we were young again and the world was new. We fittingly sat at a big round table and shared comfort food from our childhood. We actually shared so much more. We shared our individual stories, what we were doing now, and where we had been. We shared our triumphs and we shared our tragedies. We shared the story of our lives that had yet to be written when we last left off with each other. It was all simply amazing. Frank and Gary have grown up into kind, gentle and decent men. This is probably because that’s just how they were as little boys. Bill has grown up to become a thoughtful and very perceptive fellow with a whimsical touch of mirth, not unlike the "Billy" I knew as a boy. As for Joanne, who was really the catalyst for this event, she has grown into a very caring, thoughtful and obviously loving woman, whom I am sure, is a great mother to her two children. We shared a tear or two over the loss of some parents and over the loss of two classmates. We toasted them and all the others not present, but mostly we smiled and laughed with each other as we recalled the trials, tribulations and mostly fond memories of Catholic School in the 1960s. We have vowed to stay in touch and I am sure we all will. I am extraordinarily proud to count them as friends and to have them back in my life again. 

Since our dinner others from our class have resurfaced, thanks largely to Joanne’s efforts, and we are tentatively planning another larger "reunion" for later this year. 

For 4-5 hours I was indeed home again. I had returned home and with the 5 of us together nothing had changed. It was a warm feeling coupled with a sense of excited anticipation, like when you smell a fresh pie baking, or snowfall on Christmas morning, or when you hear a great old song on the radio. Like I said, it was pure magic.  

As I returned to Virginia on the Amtrak train, my thoughts wandered back to that evening. I’m sure the person across from me thought I was a bit loony when I let out an audible chuckle that seemed to come from nowhere. Ah, but I knew where it came from.
It was how far we had all come.
It was how far we had all come away from ourselves.
It came from going home again. 


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Sunset – Keuka Lake, New York

 

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Frank Edwards, MD, FACEP

 


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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.

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