Ode to Bánh mì

I had a very serious post planned for today, opening sentences poised, and paragraphs half-written, then someone told me it was National Sandwich Day, and my mouth started salivating.  Like one of Pavlov’s subjects, the word sandwich in my mind is irrevocably tied to Bánh mì which is a Vietnamese sandwich.  Now I know that a lot of these National Day of Whatever have been started for purely commercial reasons, but for a person who loves food and eating as much as I do, any excuse to eat one of these is good enough for me.  

Bánh mì thịt heo nướng with cilantro, peanuts, large cucumber slices, julienned pickled carrots and daikon radish, and jalapenos.

It wasn’t always like this.  In the small town outside of Detroit where I grew up, Vietnamese food was made only by people related to me. At home. And we were not a family who went out to eat at restaurants except for very special occasions, and then to a Szechuan place about 20 minutes away in Garden City.  The owner spoke Korean. My dad would start conversing with him, and ask for the special menu, meaning the dishes that weren’t found anywhere on the plastic printed menus with tiny red pepper symbols next to them.  Pretty soon all manner of delicious foods were paraded out and placed on the table, from fried mandu (dumplings deep-fried to a perfect crispy texture, with a slightly chewy inside layer, with seasoned meat inside, just hot enough to make you inhale sharply through pursed lips, but not hot enough to burn your tongue) to seafood dishes brimming with crab, sea cucumber, shrimp, and artistically cut, slightly crisp vegetables swimming in an oyster sauce. Delicately seasoned broths with crackling bits of rice, browned just to the point of crispiness were an entree and not part of the first course. And, at the end of the meal, my dad would not even raise an eyebrow at the bill, always leaving the owner a generous tip, which would then make my mother’s eyebrows shoot up alarmingly.

I don’t mean to say that we were deprived, as my mother has a knack for tasting a dish, and being able to replicate it, and most of us would prefer to have a home-cooked meal by her over any restaurant meal. But because of this, I grew up fairly unexposed to restaurant Vietnamese food, which is a little different from your home-cooked meals.  The only way to get these was in Windsor, Ontario, which in the pre-9/11 days, was a 20 minute drive across the Ambassador Bridge to University Street.  It felt like a foreign country, the sights and smells just like the Asian grocery store, but multiplied a hundred-fold.

This was where I first saw the classic dangling barbecued red ducks, held up ignominiously by their clawed feet.  We’d go into a number of different shops, through some algorithm in my mother’s head on who had the best prices for whatever she had in her mental list.  I never saw my mother write out a to-do list or shopping list, and constantly wish I had her memory. She mourns the fact that she has trouble remembering things now as she used to know by heart all the phone numbers for all the telephone exchanges for the military base where she met my father. I tell her her memory has subsided to normal human level now.

One of the visits was always to the herbalist, and the acrid, stinging scent brings back instant memories of the concoction she must have spent precious money on to try to fatten me up. The dark brown, murky liquid with various roots and leaves in it was brewed on the kitchen stove, then ladled into what looked to me like an impossibly large cup. A small piece of hard candy was laid next to it, as incentive to finish the entire thing, preferably without gagging or retching. The house would be permeated with the smell, and my brothers would watch me as I sat at the kitchen table, face resting on fisted hands, sympathetic but staying far enough away that they wouldn’t be noticed and possibly made to drink it, too. That was in the days when I was in such a hurry to get back to my books that food wasn’t such a priority to me, and I was, as my mother called it, “a toothpick”.

It didn’t work, unless there is a delayed effect occurring 25 years later.

Unfortunately, or fortunately, I’ve learned since then how delicious food can be.  Part of that appreciation started with the Bánh mì sandwich.  The kind my mother always bought was what is known as either bánh mì thịt nguội, or bánh mì đặc biệt.  Bánh mì is a general term for all bread in Vietnamese, however, it is also synonymous with the sandwich, which is made from a French baguette made usually with wheat and rice flour (though I’m not able to taste much difference between those with rice flour and without). It is one good by-product of the French colonial times in Vietnam.  Thịt means meat and nguội means cooled or cold.  This is also sometimes known as bánh mì đặc biệt meaning a special sandwich, which seems more than appropriate to me.  It’s filled with Vietnamese cold cuts which may include what we called Vietnamese bologna growing up or chả lụa (pork sausage), head cheese (more delicious than the name sounds, trust me), and sliced pork roasted with the classic red seasoning, and sometimes liver pâté. Though delicious, the meat wasn’t the best part of the sandwich, as it could not be complete without pickled carrots and daikon radish, julienned fresh cucumbers and cilantro. A buttery mayonnaise added some moisture and helped to bind all the ingredients together.

Fixings for bánh mì thịt nguội

Thrown in like little red hand grenades of spiciness were the deadly red Thai chilies, sliced to such minuscule portions that they were nearly impossible to ferret out completely, inevitably leading to abandoning the sandwich briefly for several glasses of water, followed by careful eyeing of the sandwich yet again, before taking the next tentative bites.  Because it is so delicious, and you think you’ve been meticulous about catching all the peppers, a few more bites will lead to thinking you are safe, and then another ninja chili will cause your tongue or lips to blossom in pain, and the whole process will begin again. These were a special treat, and each of us would get one small baguette for our own.  

These may look like ordinary Thai chili peppers to you, but be forewarned, they are stealthy and wicked.

I thought perhaps at first that it was the novelty and scarcity of the sandwich which has also been called a Vietnamese po’boy or hoagie, which was the attraction.  As I got older and got a chance to try many other kinds of sandwiches including reubens, Cubanos, Philly steak hoagies, and calzones among others (can you tell I have no issues with gluten sensitivity?), the novelty of bánh mì wore off. Or so I thought.

Then when I was in the process of moving to this high desert place we now call home, I made a phone call to the physician assistant program here, in the hopes that they might have an opening so that I could continue to be involved in educating PA students as I had in Detroit.  The PA program director told me that she did not, but would be happy to take my name, and C.V. in the event that an opening came available. As I spelled out my name for her, the tone of her voice changed from polite interest to animated questioning.

“Are you Vietnamese?” she asked.

“Yes, well, half anyway,” I replied.

“Can you speak Vietnamese?”, she asked, her voice becoming more excited.

“Um, yes?” But what does that have to do with teaching PA students I wondered to myself.

“Did you know there is a very large Vietnamese population here? And some of our students are Vietnamese.”

“No, I assumed it was mostly Spanish and Native American,” I responded, wonder dawning in my voice.

In the end, I got to teach here, and not only that I discovered the proximity of not one, but several Vietnamese sandwich shops, Vietnamese restaurants, and even a Vietnamese church. I had gone from being related to the only Vietnamese people I knew (other than those I met in college), to a city filled with them, completely on accident.

And so I did the only thing I could do.  I went to every Vietnamese place I could find to try the bánh mì (and the phở, but that’s another blog post). Purely for research purposes, of course. I discovered bánh mì thịt heo nướng, what I now call the gateway bánh mì, filled with seasoned roast pork, a sandwich no one I’ve ever introduced to has ever disliked. And, like so many other things, I’ve discovered that there are many right ways to make a bánh mì, all of them informed by personal choice, with variations in bread which is normally baked on site, fillings, types of vegetables included, consistency of mayonnaise (which is definitely not Hellman’s) and chilis used. Here in the Southwest, those red ninja-stealth chilis have been replaced by jalapenos, which when seeded and sliced, often look just like the much more innocuous green pepper.

Fresh, they could be green peppers in your sandwich. Except green peppers don’t make your lips feel like they want to fall off.

Same effect, different chili, but still delicious.  It turns out I was wrong. I’m pretty partial to bánh mì, even if I can have one every day.

Not that I do.

Or have done.

Not yet, anyway.

Though I’m not a tshirt collecting person, I would wear this.

Love, Despite

 

Before I married my husband, I told him to make sure that he was marrying me for who I was that day, and not for any future changes he hoped to have wrought in me through the “transforming” power of marriage. Though we were both young, I had seen enough unhappy marriages to make me wary of the institution, and who wants to be institutionalized, really?  I had no question that I wanted to spend the rest of my life with him, but I wanted us to start off with as little illusion as possible.  I wanted to know that he saw me, and not some airbrushed version of a girl to be placed on a pedestal.  It is easy to fall in love if you believe all the fairy tales and movies.  Beautiful women with flowing hair and flawless skin meet muscled men with pure hearts and chivalrous intentions and they ride off to his manor with servants aplenty to watch the perfectly well-behaved children gambol across the lawn.

Real life, though, is grittier.  The muscled boy that you met at 18 will have to help you get to the bathroom after giving birth to an almost 9 lb baby, change that baby’s first meconium-filled diaper, and not comment on all the broken blood vessels across your face from pushing to get that giant-headed child out. Those flowing locks that you used to have time to tame into submission, will subside into their normal frizzy state, then fall out during pregnancy so you look like an alien who accidentally swallowed a giant watermelon.  The manor will actually be a tiny little starter home surrounded by other tiny little starter homes where you can hear your neighbors argue and flush their toilets. Those perfectly well-behaved children will kick a soccer ball right through your basement window after being sent outside so you can think in silence for 2 blessed minutes before you erupt into acid-spewing dragon mama mode, yet again.

What is not easy, is staying in love, loving, actually choosing to love, when face it, there are times when we are not lovable.  When we are angry at the burned beef stew and there is not a single, flipping thing ready to eat in the house and everyone is hungry.  When we are frustrated at piles of bills and broken car innards, and then the dentist says your child needs braces and it’s going to cost you exactly what you planned to spend on the car repairs.  When we are already late to church for the umpteenth time, and we scream hurry up at the child who has to go to the bathroom right now.  When we slam the phone down multiple times, because once is just not enough.  And does anyone else agree that hitting the end button on our cell phones multiple times is just not the same?!  We are so often not at our best, so often not that serene  image of our best self that we aspire to, and carry around in our heads.  And yet, and yet, we continue to love one another, despite. We continue to hold on, in a world that does not value the sanctity of marriage or family or friendship.

Last Sunday’s Gospel described Jesus’ tranfiguration on the mountain.  Every time I hear this passage, I giggle a little to myself at Peter’s response to the incredible change he is witness to, but then wonder myself at what I might have said or done in his shoes. In reality, though, we see one another every day transformed. We see past the imperfections and flaws–frizzy hair, receding hairlines, extra pounds, impatience, frustration, and love one another.  That is the tranfigurative power of love, and we do not have to look to the mountaintops, or what others refer to as those thin places where the divine is closer to us mortals, to see that transfiguration.  We see it everyday when we choose to love despite and not because. We do it everyday, when we call one another Mình ơi, or sweetheart, when we are definitely not being sweet nor acting like the best reflection of our selves.

Today I am thankful for love that echoes the divine, that transforms us into our most ideal selves. I pray for the fortitude to keep trying to love despite and not because.  I am grateful for the lack of illusions that makes marriage a safe harbor despite all my fears to the contrary, and for books which not only enthrall us, but also give us inspiration through words of wisdom which are gifts unto themselves.

“It had flaws, but what does that matter when it comes to matters of the heart? We love what we love. Reason does not enter into it. In many ways, unwise love is the truest love. Anyone can love a thing because. That’s as easy as putting a penny in your pocket. But to love something despite. To know the flaws and love them too. That is rare and pure and perfect.”
― Patrick Rothfuss, The Wise Man’s Fear

The Power of Names

I am a true believer in the power of a name.  Perhaps it is because as a writer, I know the power words can have to change mindsets and attitudes.  Perhaps it is because I grew up with the story of how my name came to be, and saw how it came to be both a self-fulfilling prophecy and revealing of my true personality.  Perhaps it is just because there is always a story behind each person’s name, and I love stories. Mine begins in Saigon, where I was born to a Korean father and a Vietnamese mother.  Whenever I tell people this, I always get the same reaction–“That’s a strange combination”.  Having never known any different, I really can’t say why this is, but purely from a personality standpoint, I can say my parents are two entirely different people.

Though both my mother and father grew up poor in war-torn countries, their stories are very different.   My father tells me stories of hiding out in the mountains of Korea from Japanese soldiers, and moving from city to city as my grandfather searched for work.  My mother wielded a machete to make her way through the jungles near her village in Vietnam while she scrounged for firewood and stole fruit from the trees of neighbors.  My father is a second son of six children, a golden boy who began providing for his family at a young age, helping to put his sisters through school.  My mother is the second-oldest daughter, but 3rd from the youngest of my grandmother’s eleven children, growing up in a very Catholic family.  My father loves music, art, and museums.  My mother was forbidden from reading novels with our family’s strict Catholic upbringing, but there wasn’t much money for novels anyway.  Before he came to Vietnam, my father had traveled all over, taking photographs with his Nikon and reportedly, as my mother teases him, leaving a trail of broken hearts.  My mother was betrothed to marry a boy from the next village over, but having never been there or met him, finagled her way out of the engagement by “forgetting” to notify him of her father’s death, thereby prolonging the time he would traditionally have to wait to marry her from 3 months to  3 yrs  (after the mourning period for her father had ended).  My father, a cultured man 17 years my mother’s senior fell madly in love with the determined young village girl, even going so far as converting from Buddhism to Catholicism to obtain permission from my grandmother to marry.

When I was born, my parents consulted a numerologist for help in naming their first-born daughter.  This to me is one of the most puzzling parts of the story.  When the story was told to me when I was a child, it was said as matter of factly as one might say “And then we took you home from the hospital.”  Looking back on the story now, I have a multitude of questions.  How long does such a process take?  Where might one find a good numerologist in Saigon? Was his or her name on a bulletin board in the waiting room of the hospital?  Was this a normal part of the naming process for everyone at that time?  My father was a fire chief, then a field engineer for the American military base in Saigon, work that is very concrete and physical.  My mother is the most practical person I’ve ever met. The concept of a numerologist being part of the naming process for these 2 people does not fit.  And yet, that is what I am told happened next.  This numerologist took all of our numbers, which I assume consisted of dates of birth for my mother, father, and me, and perhaps the time of my birth, and decided that I would be the peacekeeper between my mother and father, because they are such different people.  Thus my first name and middle name are meant to be said together, translating roughly into “the source of peace and happiness.”

I was in elementary school at the time I heard this story.  If you have children of your own, you realize early on that they arrive in this world with certain personality traits and qualities that emerge and persist.  My two daughters are both perfectionists.  My oldest is soft-spoken and prefers to avoid the spotlight.  My middle child is not soft-spoken, and prefers to do things her way.  My son is perceptive about people, and sensitive to their emotional states.  These are characteristics which are innate to them, ones that I cannot change, even if I were to try, and nothing that I knowingly taught to them.  From childhood, even before I heard the story of my name, I strived for accord between my friends or other children on the playground.  Am I who I am today because of my name?  Or was it just serendipitous that my name reflects the personality with which I was born?  I can’t recall consciously deciding to be someone who brings happiness and peace to others, as it seems to me to a worthy goal for any and every person, but did the knowledge of my name help to firm my nascent and innate desire to be a peacemaker?  Without a time machine, it is a mystery to know how different each of our lives might have been with different names.  Was the fact that my name’s meaning is positive change my perception about my life’s path?  I look at some of the more unusual baby names and wonder what will become of these children named Puppy or Pepsi.  My children are not named Puppy or Pepsi.

When my sister was born, here in America, my father asked for my help in naming her.  Thinking about this now, this also strikes me as strange, given that I had just turned 8.  I took the task very seriously though.  Being a very literary little girl, I went to my favorite stories.  At the top of my list of names was Josephine, for my favorite character in Little Women, and Sara after Sara Crewe from The Little Princess.  These girls were brave, smart, and kind.  These are the characteristics I hoped for in my first and only sister.  My father took my list of suggestions and actually chose one of the names I had provided.  And my sister is brave, smart, and kind.  I can’t take any of the credit for these virtues though I did help to name her.  She was born that way.

Today, I am thankful for my baby sister.  Sis, I’m sorry I forgot to warn you not to read this one in public.  I am grateful that my parents put thought into naming me and all of my siblings, and that none of us have names that might predispose us to being serial killers.  And as always, I am thankful for the power of names and words to change lives.

I love to hear stories of names.  So please feel free to share yours.  What is the story behind your name or the names you chose for your children or pets?  Do you think the meaning behind your name had any effect on who you are? Did you change your name, and if so, why?

Here is an article about the unusual names people have chosen for their babies in 2013, Pepsi and Puppy being real names, unfortunately:

http://www.dailymail.co.uk/femail/article-2529425/Vogue-Nirvana-Tea-Reem-PEPPA-The-bizarre-baby-names-2013.html

The time machine I would use to explore alternative universes in which my name was not influenced by the numerologist.

Source: http://img.photobucket.com/albums/v291/Riverwolf/tardis.jpg

A Heart Like No Other

I had the privilege of being the last to hear my grandmother’s heart beat.  When you pronounce someone in a hospital, there are usually heart monitors and other machines to confirm their passing.  A host of other medical professionals are usually standing by, and a curious stillness after the cacophony of chest compressions and beeping machines enters the room.  It is like a held breath, just long enough for the exact hour and minute to be noted, and then everything begins again, the clock restarted, time marching onward.  Gloves snap, charts close, trays rattle, and all the people melt away, on to the next pressing task.

In hospitals, signs of holidays are everywhere to keep patients oriented to time and place, and to cheer up staff and visitors.  Valentine’s Day is no different, red and pink hearts decorating hallways and doors.  Perhaps because my work was in cardiology, Valentine’s Day always carries a different meaning for me, all the emphasis on hearts reminding me of the steady beats I listen to every day.

The night my grandmother passed away, the rhythmic rise and fall of soft, sad voices in prayer filled the spaces between each beat and breath.  I knelt beside her bed, my fingers on her pulse, feeling the erratic beats slow.  Without a monitor, I had to trust my trembling hands to lay my stethoscope on her chest.

Absence of sound is a funny thing.  You have to listen longer, to the in-between spaces that stretch out, a ribbon of silence, and it is you that pulls away, weighing the likelihood of sound against your willingness to listen further.  I bend my neck, a prayer, the blessing of this moment heavy on my head.

In that moment, I am a child again, kneeling at my grandmother’s bedside, hesitantly echoing her words, the air in the darkened room heavy and still, time marked not by the ticking of a clock, but by decades of Hail Marys.  In those hours at her feet, the sounds of my mother’s country molded my tongue, and I say the Sign of the Cross in Vietnamese, joining my family in benediction and intercession.  I look at my watch, unable to see the numbers through my tears.

My grandmother was born in the Year of the Snake. Like clocks, a calendar in those days wasn’t important, the tasks of the day tied to the setting of the sun and the turning of the seasons from wet to dry, harvest to sowing, and so we don’t know her exact birth date.   It seems wrong somehow, that instead of honoring the date she came into this world, we observe the date of her death.  She was not sad, but ready, longing to be in Heaven with her angels, two little boys who died in childhood, in the days before vaccines or antibiotics.  I learned about the power of grief from her, as she told me stories about her clever little boys, rheumy eyes still wet with memories from decades long before, when she was a young mother losing her sons.

I grew up under those watchful eyes, her hands always slightly gnarled, but soft and smooth, as if the years of running rosary beads between her fingers had transferred the smoothness to them.  My earliest memories are of being with her, eating crusty French bread dipped in Borden’s condensed milk, or walking around our apartment complex through early morning dew.  She never really seemed to age, until after I moved out into my own home, married with children of my own, carrying my stethoscope like a talisman as I made my way through the world.

In the year before she died, my grandmother was hospitalized where I frequently did rounds.  In that hospital bed, surrounded by those beeping machines, she was so much smaller than I remembered, and so much less herself.  The nurses and physicians would comment on what a sweet patient she was, and how attentive my family was, as she was never left alone.  Though she received excellent care from the staff, I am grateful that she did not die in that hospital bed.  Instead she died at home in her own bed, surrounded by family.  The oxygen saturation of her last breath was not measured, her arms lay untouched by IVs or needles, my stethoscope the only foreign thing in her room.  Hers was the most peaceful death I have ever witnessed.

There were no machines, no trays, no gloves, just the soft touch of loving hands folded in prayer.  I do not know the hour or the minute of her passing, and it is not noted in anyone’s chart. I know it was the year of the Dog, and that my grandmother finally went home to be with her angels.

http://dailypost.wordpress.com/2014/02/10/writing-challenge-valentine/

The Call

As a firefighter’s wife, you learn to accept certain things as part of the job.  When he was a volunteer for two different fire departments, sliding out from under warm covers in brutal Michigan winters to get to the scene of another person with difficulty breathing or another structure fire, I learned how to go right back to sleep before he had even finished putting on his boots.  When he came home with bandaged hands and told me he could not wear his wedding ring anymore because 100 pullups made his hands bleed while in the Fire Academy, I learned how to apply antibacterial ointment without adding the salt of my tears.  When he got held over because he was force-hired when another paramedic was ill, I learned how to rearrange schedules for pick-up for dance class, Cub Scouts, Girl Scouts, and soccer without even a change in heart rate.

As a physician assistant, I thought perhaps I had an advantage over other firefighter’s wives.  I’ve been trained on how to react in emergencies, explained to wide-eyed patients that the chest pain they felt was not indigestion, sutured gunshot wounds, bloodied numerous pairs of gloves in procedures and surgery, and so thought I was prepared for the life as the wife of a firefighter.  And then, in one moment, this illusion which I clung to was swept away.

It was a simple photo. Taken by his partner in a candid moment after a house fire, then posted to Facebook.  When he first became a firefighter, he would call me on his way home, just to let me know he was still alive, and this habit continued at his new department, after he got off from his shift.  Frequently, his calls come while I am with a patient, so the conversation consists of only a few reassuring words, but it is enough to let me know the world is as it should be.  He is safe for another day.

Like most couples, at the end of the day, we share work stories. Since he is a paramedic/firefighter, we discuss Patient X, treatments, and transports, and our children are used to dinner table stories of crashes and fires, though most stories have to be edited for little ears.  He will say only “It was a bad one,” and I know it will be a conversation for later after bedtime stories, nighttime prayers, and goodnight kisses.  I have heard so many variations of cases, and somehow this has lulled me into thinking of them as routine, part of the job, just another fire.

On this day, I am between patients, checking Facebook, this picture of him, so unlike most I’ve seen pops up on my screen.  My son has inherited his daddy’s smile, all cheeks and teeth, full of life and laughter, infectious and enthusiastic for all the blessings we are surrounded by, and pictures of my men are lit by these smiles.  But not this picture.

In this picture, he is tired.  The house smolders behind him.  The air is thick with the haze of smoke. The ground in this desert city in which we now live is wet with the efforts of hours, and criss-crossed by hoses.  The uniform which I’ve seen hanging in his locker, is smudged with soot.  The helmet with his name emblazoned across the front is held in one hand, and I can see that he is trying to muster up the energy for that brilliant smile, but he can’t quite manage it.

I have visited each of his fire stations, trying to nod knowledgeably as he points out gleaming rows of knobs and levers on the fire trucks, listened to explanations of all the safety equipment and training, shook hands with his station mates, but, of course, I’ve never been on scene.

Never seen the fires raging, smoke billowing, men and women moving in concert to save lives and homes.  Never seen this man, who gave up a lucrative position to go back to school for his 3rd career finally doing what he loves, look like this.  This man whom I met as a boy, who asked to hold my hand 3 babies ago, who loves being a firefighter because he can help people, looks out at the camera, and I finally see him, in his element, and my heart contracts in fear.

I am a firefighter’s wife.  I thought I knew what that meant until this photo.  And later, when I get that call, that tells me he is home, and safe. . .I know it is only for today.  And I pray, with renewed urgency for strength to a merciful God and His blessed mother, that I and all the other partners of firefighters, continue to receive that call.

No Such Thing as an Accident

“Oh no, oh no! Oh my God, look at that car! It’s a rollover!”

Looking up from my phone, I gasped, “There’s someone lying on the highway!”

Seconds later, our truck is in park just past the battered now windowless Honda Civic angled diagonally across the slow lane, the front end resting on the guard rail.  A motionless woman lies partially across the dotted white lines in the fast lane.

“Stay with the kids. Call 911!”

I dial with shaking fingers, window rolled down to try to see where we are at almost 9 o’clock at night on westbound interstate 44, not even feeling the frigid wind blowing into the cab. I had been fiddling with my phone trying to get a signal, trying to find a vacancy in Joplin on New Year’s Eve’s eve, when I looked up to see a movement so wrong your brain can’t comprehend why a car is flipping end over end towards you on the freeway.

We shouldn’t have been there at that exact moment. Our drive out to Michigan had been so uneventful, I wondered why we’d been so leery to drive across the country for Christmas before. Beautiful weather, no construction barrels or traffic slow-downs–it was truly a blessing.

Then, on the way back from the night session of snowboarding at Alpine Valley, a trans line blows, leaving him and the kids stranded at the end of an exit ramp on I-275. We brought 12 quarts of transmission fluid to him, covered in dirt, oil and trans fluid from crawling under the truck to patch the line, shivering violently in the dark in -4 degree weather.

8 quarts was enough to limp home, then the next day he spent repairing it properly in the warmth of his old firehouse thanks to the brotherhood of firefighters, his buddy towing him the rest of the way when it broke down again. He gave my husband some gloves in case it broke down again.

I worried afterward, though it ran smoothly, that it wouldn’t make the 2-day trek home.

“It shifts a little funny, but it should be ok,” he said. We should have left an extra day early because he’s on shift New Year’s Day.

Because I was busy talking with my brother’s new fiancée, we finally left 30 minutes later then usual from my mother’s to head back home. As we left Michigan, I saw tucked in the clouds a tiny square of a rainbow.

“Look, kiddos, it’s a rainbow cloud!”

“I see it, Mama! That’s so cool!” my son said.  I’d never seen such a tiny little square of rainbow before and because of the way my brain works, I wondered at the significance of the symbol of God’s promise peeking at us at the start of our trip, but it was quickly forgotten in the squalls that hit us as we crossed into Ohio. We slowed to 40 mph in the near white-out conditions.  We made more stops after that then we normally do, because we had used up all the windshield wiper fluid, for bathroom breaks, for wrong exits, and for fuel while trying to find a decent price for diesel, then sat in traffic in Indiana because of a semi-truck accident being cleared. He grumbled at the delays, mad at the GPS spinning wildly in unmapped, un-updated territory, amazed at the audacity of uncaring gas station clerks who couldn’t figure out how to set the gas pumps.  Without all those delays, we would have made it all the way to Tulsa to find a place to sleep.

Instead, we were 40+ miles outside of Joplin, in 16 degree weather, first on scene for an ejection rollover.

“Help, I need some help! Please help me get up and off the road!”

“Ma’am, please don’t move! I’m sorry, I can’t move you until the ambulance comes. Everything is going to be ok,” my husband reassured her.

The other lady had some back pain, but he told her to stay in the car out of the wind. There was surprisingly less side damage to the car so he was able to wrench open the door to the backseat where she had crawled to get out since the crushed front end had damaged the front passenger door. He stayed crouched at the side of the woman on the street trying to keep her from moving and helped to coordinate with the sheriff’s deputy all the people who stopped to help.

Because of the snow and salt, the windows in the back of the truck were opaque enough to block the view of the poor moaning woman in the road from the kids. They were worried and scared for the people, but calmed after I pointed out all the people who had stopped to help.

Within minutes, other people had pulled over to help, a man in a puffy ski jacket crunching through the debris, cell phone to ear.   An older woman in a hat with a pompom on top asked me, “Is that a dog?”

“No, it’s a person,” I replied, while trying to give our location to the 911 operator.

“I’m going to connect you with Lewiston,” the operator said.

“A police car just arrived, but we need an ambulance right away.  Please hurry. There are 2 patients, and one was ejected from the car and is laying in the road. My husband is a paramedic, but she needs to get to a hospital,” I said, breathless with worry.

He headed back to the truck to get the coat he’d left behind when he threw it into park.  “I need gloves, honey. Amazingly, they are both conscious and moving,” he reassured the kids. I handed him 3 or 4 pairs of gloves, and he headed back into the cold.

Someone found a blanket and jacket and covered her. Another person brought him a C- collar, and a travelling nurse helped him fasten it.  The ambulance arrived, parking far away, until my husband motioned the rig closer, directing the EMTs and helping to gently load her from the split/scoop backboard onto the stretcher. The sheriff’s deputy and a thin brunette with a flashlight helped to keep control of the scene, and a friendly state trooper arrived to assess the situation.

Both people are lucid and were on the way to the hospital when we left. Please say some prayers for them, and please, please wear your seat belts.

If you doubt there are good people in the world or that things don’t happen for a reason, at least 9 people stopped to help in blowing wind and below freezing temperatures.  The semi-truck travelling behind us saw us pull over so he was able to avoid running over the woman, then parked his truck to block traffic and protect her. One of the people who stopped to help was an off-duty sheriff’s deputy with his wife who is a dispatcher travelling eastbound, and they were able to call it in as they were turning around so the ambulance arrived quickly.  Several others who stopped were EMTs.  All of these people melted back into the dark anonymity of night, headed back to their destinations, glad to be in the right place at the right time.

Happy 2017 everyone. May you always be exactly where God needs you. I pray that 2018 is filled with blessings for you and yours!

How Do You Solve a Problem Like Maria?

One month ago today on Friday the 13th, I flew into San Juan, Puerto Rico.  I volunteered to serve as part of the VA Disaster Employee Medical Personnel System (DEMPS) to assist with disaster relief efforts after Hurricane Maria touched down on 9/20.  I fully intended to write a journal entry every day, just to capture the memories that can be so fleeting in the moment.  I wrote one short blog post on the bus ride to the temporary Federal Medical Station at the Acrópolis de Manatí that I never published, then never wrote another word until now.

Acrópolis de Manatí before

View of the FMS at Acrópolis de Manatí from where we slept.

Though people have asked me over and over about the experience, though I dream nightly of being there still, and though I know I am forever changed by the patients I cared for and the friendships I made in Puerto Rico, I have been unable to find the words to express what I feel and think about it without feeling completely inadequate to the task, the weight of the experience anchoring my tongue and laying heavy on my mind.

“How do you solve a problem like Maria?
How do you catch a cloud and pin it down?
How do you find a word that means Maria?”

These lyrics from one of my favorite movies are on rewind in my head, the incongruent cheerful riff at odds with the churning emotions inside.  I am in contact still with some of the incredible people I met and worked side-by-side with in Puerto Rico.  I’ve shared some of their eloquence to give friends and family who ask a small glimmer of what it was like, but it feels a little like borrowed elegance, a little like cowardice to hold back what I’ve turned over and over in my mind like a many-faceted gem, and a whole lot like the type of pressure I feel always to paint the picture right the first time. I kept biding my time, waiting for the perfect words to come.

Then recently while at dinner in Phoenix, I had a sudden sharp pain in my L eye.  It felt like a torn contact lens, the sharp edges drawing across my sclera. I thought nothing of it, and driving to dinner with another friend, I noted a larger than usual amount of blood in the centrolateral aspect of my L eye from a subconjunctival hemorrhage.  Confirming this with my fellow PAs (really what better place for a curbside consult than at a leadership conference for PAs?), I knew it required no specific medical care.  On my 7-hour drive home from the conference, I mentioned that this had been the 4th one in less than a year or perhaps 6 months to my good friend, who happens to be an acupuncturist.  She gently reminded me that after travelling to Columbus for the National Girl Scout convention with Daughter #2, two weeks working nearly nonstop in Manatí, a short week home, then another nearly week-long conference in Phoenix, I might consider that I need rest.  Apparently the sclerology chart she sent to me indicates that the area of my eye affected points to a possible problem of the heart.

As a former cardiology PA, I know there is nothing wrong with my heart. I also know that when I think about Puerto Rico, I feel a pressure in my chest that has nothing to do with a myocardial infarction, and everything to do with another type of blockage, the kind that comes from feeling something so strongly, and being unable to talk about it in any kind of coherent way. I get updates from DEMPS personnel who replaced us there about patients I took care of, and it makes me wonder.  How is it possible to love being home with my family and wanting so badly to be back in Manatí, in a place where I don’t speak the language, but where I understand perfectly what my purpose is?  How can it be that everything here goes on as normal, commuters driving badly to work, kids struggling with slope and y-intercept homework, and at the FMS Manatí, patients whom I cared for still have no home to go to and still have no power for basic needs? How can it be that my patients are dying, and I can’t do anymore about it now than I could then?

I struggled with these thoughts, overthinking perhaps that by talking about it, I might be exploiting the prurient aspects of seeing a disaster up-close versus the need to show people what it is really like there in this era of “fake news.” And then today, a NY Times article about the mental health crisis affecting Puerto Rico was featured, and the trolls online could not type fast enough about how we are wasting money on an island that isn’t even a real part of the US, and I told myself it was time to tell the story. The 2 questions I’ve been asked most frequently: “Is it really as bad over there as they say it is?” and “What was it really like over there?” The short answers: Yes, and terrible, but wonderful.

The long answer, well, that’s harder. That’s going to take more than 1 blog post to answer.  And I promise you, it will not be any semblance of a perfectly presented answer to the question of how to solve the problem of Maria and its effect on the people of Puerto Rico.  It will be my truth about the privilege of being a PA serving as one small part of the federal medical response to Hurricane Maria with fellow VA employees in the DEMPS program, DMAT, DoD, USPHS, ICE, and volunteers from New York Presbyterian Hospital.  Stay tuned–there won’t be any nuns breaking into song, but there will be cake, clowns, and cops with rhythm.  There will also be stories about patients that will make you rethink what you know about love and devotion. It was my privilege to witness all of it.

Special thanks to my husband, my mother, and my friends who took over mom duties at home so that I could go and serve. I could not have done this without their support.  I love all of you more than I can say.

If you’d like to help the people of Puerto Rico:  https://www.fema.gov/news-release/2017/09/22/how-help-after-hurricane-maria

This is the main page for up-to-date resources and information on the federal response to Hurricane Maria:  https://www.fema.gov/hurricane-maria

This link will take you directly to the statistics for Puerto Rico: https://www.fema.gov/disaster/4339

The NY Times article about the mental health crisis in Puerto Rico that finally broke the dam holding in the words:

It’s Complicated

Today started off beautifully. I sailed through traffic with nary a hiccup or police officer glancing suspiciously at my lead-footed progress, managing miraculously to get to work early enough to sip a cup of tea since the first patient of the day hadn’t shown up. It then rapidly progressed downhill.  He did end up showing up 20 minutes late, and though a very nice man and fascinating to talk with, possessed a medical history complicated enough to make him the interesting kind of patient you never want to be.  My next patient showed up early, and being now already behind, had an even more complicated history, putting me another 30 minutes behind. The next patient was on time, but because I was already running late, got picked up 35 minutes late, and he and his daughter had a million questions, all of them asked with upraised eyebrows, furrowed 11’s masking the concern that I would be yet another person to deflect and dive away from the hard questions.  They were not angry with me, but I am the face of a system of bureaucracy maligned by the media, painted with the wide tar brush of suspicion from so many other whispers of incompetency, and I’m the target sitting there available. These are the patients I take as personal challenges to rebuild the trust that has been damaged. I answer as many questions as thoroughly and honestly as I can, and when they leave, they both hug me. I take a deep breath, then head to the next patient. These are the days I feel like I’ve sprinted the entire day, throwing food towards my growling stomach in between patients, and arriving at the end of the day, out of breath, out of words, and knowing the marathon is not yet over, and it will begin again the next day.

So, why do I do what I do?  Why be a PA, when medicine is not a science, we don’t have all the answers, health care costs increase every day, and people mistake me for the med tech when I call their name at the door of the waiting room? Why work at the VA, when as a PA there are jobs available all over the country in any other environment I might be willing to work in?

https://i0.wp.com/www.bookglow.net/wp-content/uploads/2016/12/featured-graphic-2.jpg?fit=800%2C520

It’s complicated, as they say in Facebook lingo.  As a PA, I’m privileged to witness some pretty incredible moments: When a patient feels comfortable enough with me to share her story of military sexual assault for the first time ever, and I’m able to navigate all the protocols to get her seen by a psychologist that day. When an observation I make as part of my routine physical exam helps a patient finally get to the crux of what’s causing his headaches. When a long-time smoker tells me he finally is going to quit because today’s combination of advice and his journey to get to this point happened to coincide. When today a patient promises not to hurt himself or others, and I believe him.  When stories of helicopter pilots, TDYs to Micronesia, and military couples married for 48 years weave in and out of a patient’s narrative. These are the blessings and victories that get me through the sprint to the end of the day. These are the reasons I feel blessed to be a PA taking care of veterans.

We call it practicing medicine for a reason.  It is impossible to know everything in medicine.  The rate of knowledge we are acquiring about the human body is mind-boggling, but nowhere near comprehensive. And every day, “truths ” are revealed as falsehoods. As a PA, I feel free to admit I don’t know everything, and as a PA I am so glad my adopted state and my home state of Michigan allows me the freedom to practice to the top of my licensure. I don’t practice medicine in a vacuum, and don’t know anyone who does. We could not exist without our team — other PAs, nurses, collaborating physicians, med techs, pharmacists, respiratory therapists, psychologists, social workers …the list is long, but for anyone to say they know and can do everything for a patient, that is hubris, plain and simple. I’ve been blessed to move into a new position and am learning so much about leadership and all the fascinating behind-the-scenes mechanisms that run the largest healthcare system in the world, which just makes my nerd-self happy, but also makes me grateful for those in administration who do that thankless work without the gratification I get from my one-on-one time with my patients. I’ll never give up clinical medicine for the administrative stuff, but the knowledge I’m gaining is making me a better clinician and advocate for my profession.
Tomorrow is the start of PA week which runs from 10/6-10/12. It marks the 50th anniversary of our profession. The first PAs were Navy Hospital Corpsman who had a wealth of knowledge and experience coming out of the Vietnam War. Dr. Eugene Stead recognized it would be a waste to let that expertise slip away, and created the PA profession based on fast-track training for WWII physicians to fulfill healthcare shortages that continue to this day. This also echoed a similar earlier concept found in Russia known as the feldshers.

Now PAs work in all branches of medicine in all the states and territories of our nation. The concept has spread to Europe and Australia. You can find PAs not just in hospitals and clinics, but also in schools, back on the battlefield, in the boardroom, in publishing fields, pushing boundaries in research, in front of the classroom and getting MBAs.

Today I honor those first PAs who blazed the way for the rest of us, the doctor who had the foresight to see PAs as valuable members of a healthcare team, and the mentors who pushed us all to aim higher. Here’s looking at what we can achieve together in the next 50 years!

Hello September

via Daily Prompt: Critical

“Mama, I’m so sad for her.”  My sensitive daughter, as awkward socially as I was at her age, has a big heart.  She has had friends battling big demons, problems that I hope my children and your children will never have to deal with, and comes to me with questions on how to help them.  She wants to know why her friends who are so sad, can’t see that she wants to help them, to be a shoulder to cry on, and a listening ear, and can’t understand why that is not enough to fix their problems.  These friends thankfully have loving parents who are getting them the help they need. My children have been lucky enough to grow up with plenty, a mother and father who love them and each other fiercely, a family bonded across miles by real affection and goofy humor with both sets of grandparents, aunts, uncles and innumerable cousins, friends who are steady and enough of a tribe to create a blanket of security. But even having all of the above doesn’t make you immune to trouble.  Having to confront the turmoil of the teenage years so early definitely feels like summer is over.

It’s September, which for most people brings to mind crisp, cool evenings and pumpkin-flavored everything (to my husband’s chagrin).  Fall is my favorite time of year and the smell of school supplies makes my nerd-heart want to dance.  But September also stands for something very real and very critical.

September 1 kicks off National Suicide Prevention Month.  I remember the first (and unfortunately, not the last) time suicide touched my life. I was 13, the same age as my daughter now, and a boy from my school whom I did not know had taken his life over the weekend.  I saw girls crying in the hallways.  Many of them talked about the last time they had seen him, their last words with him, or memories they had shared.    The question overwhelmingly asked is the same question my daughter asks me now. Why?

For those who have never felt this way, it can seem incomprehensible.  Many of my veterans struggle with this, as well as many first-responders, but we can’t forget that even kids can feel this way, and don’t have the maturity to think through the very real consequences to actions that can be heart-breaking.

I tried to explain to my daughter what I think it is like when you are so depressed and full of despair that you think life cannot get better.  I told her that even though her friends know that she cares deeply for them, it is like being at the bottom of a hole so deep and so dark, that even though you know the way out is up there, it feels so far away that you cannot even see the light, or if you do, you’re not sure if it’s just your eyes playing tricks on you.  And you feel so tired that trying to get to that light is hard, and curling up in yourself feels so much easier.

She said hopefully, “I could climb down in the hole and pull her out. I’m pretty strong, even though everyone calls me skinny.”

Man, I love this kid so much.  So I hugged her, even though at 13, she’s not always into hugs no matter how much I tell her everyone needs a minimum number of hugs a day to stay healthy. https://www.scientificamerican.com/article/a-hug-a-day-keeps-the-doctor-away/

And I told her that being a kid, it would be too hard to climb down in that hole, because it’s her friend’s pit, and even adults sometimes can’t climb down there, but that she could keep trying to extend a hand to her friend by being the best friend to her she can be and telling her that she cares about her so she knows which direction is out, but that no matter how far down she reaches into that deep, dark hole, her friend has to climb up far enough to grab on, because no one else can climb those walls but the person who is at the bottom of the hole.  And hopefully with help, they can do that, but it takes work and time, and never giving up. And being with someone who is trying to do that can make you feel helpless.

We aren’t helpless though.  What we can do is to recognize that those we love may be at the bottom of that pit of despair even if it doesn’t seem like it to everyone else.  We can shine a light to show the way out, share words of encouragement and provide nourishment for the soul with kind words for the hard journey, but no one can travel that road for them, though we can walk with them.  It is a hard thing to say to a child of 13, and a harder one for an adult who sees others suffering to know, but the hardest task is figuring out who is in need and trying to help them before it is too late.

My attempt to capture the eclipse

I’m sharing this because you can never know what lies in the heart of another.  Please be kind to one another. Be that light for someone. We never know what demons others are battling, with bright smiles and shining eyes, Facebook posts filled with kids starting school and Labor Day plans.  It starts with awareness.  And a good heart, whether you are a confused 13-year-old with skinny arms or a mom who wishes she were better at these kinds of talks.

Finding Our Stars

When I was 12 years old, I wrote a silly poem called “A Well-Rounded Gal” featuring lines about being able to recite poetry while standing on my head wielding a sword with my left hand, and all manner of other skills that a prepubescent girl who’d read all the classic Arthurian, science fiction and fantasy novels thought were requisite to qualify as a Renaissance woman. Though the list was a bit on the fantastical side (though I would still love to learn how to properly sword-fight), in reality, like everyone I think, I kept a mental list of things I wanted to be knowledgeable about, skills I thought a real adult would know. Perhaps it is part of the pitfalls of perfectionism or some crackpot bill of goods sold to all of us, that dangles that carrot of “If Only”, this feeling of inadequacy that comes from knowing less than I should.  It’s not that Socratic knowing-what-I-don’t-know inspiration that prompts us to seek knowledge, but the palm-sweat inducing sensation brought on by the sound of “should.”

On that mental list that a Renaissance, always-prepared Girl Scout dragon mama carried in the toolbox is the ability to navigate by way of the constellations. Now as anyone who knows me will tell you, I have a terrible sense of direction. I frequently turn left, meaning to turn right.  I get lost, or as I call it “go adventuring” on a regular basis–in places I’ve lived for years.  I’ve learned that when in doubt, whichever way my instinct tells me to go, I should go the opposite, which is then usually the correct way home. Before we moved to a place where my mountain is always in the East, determining where North lies without GPS was a multi-step process that involved:

1. Looking to first determine where the sun was in relation to where I was (not as easy as you think in a state like Michigan where it’s frequently overcast).

2. Humming the lines to an old Girl Scout song: “The golden sun sinks in the West, Great Spirit calls Girl Scouts to rest… ”

3. Recalling which way I-75 runs, and where I was in relation to this freeway

4.Imagining a compass rose and mentally walking around this to determine in which direction lay North.

So, perhaps being able to navigate by the stars is asking a bit much.  I would be willing to settle for being able to find the constellations, I thought.

So when my middle daughter asked me to come as a chaperone on the school trip to the planetarium, I was stoked. Here was an opportunity to add to my repository of Renaissance woman skills. Our astronomer guide was a woman who had clearly given the talk to elementary school children numerous times throughout the years. One thing I had not counted on was how dark the giant room became once she shut off the lights so we could look up at the ceiling and pretend we were looking up at the night sky.  It was breathtaking, and enlightening, but unfortunately, my super-hero power of being able to sleep anywhere at any time kicked in.  Life skill NOT achieved, though a refreshing nap was had, luckily without any embarrassing snores.

The next opportunity for redemption presented itself at our trip to Chaco Canyon with the Boy Scouts.  The ranger gathered us for a hike after dark (which in my mind seemed like a great opportunity to sprain ankles or have small children fall into gullies) then began speaking about the ancient people who had built the mysterious dwelling places at Chaco Canyon. He told a legend of how the stars were placed in the sky, the constellations a way of explaining how the world began, when crops should be planted, how men and women interacted, and as we sat under the brightening stars waiting for the moon to rise and show us the way, he recounted how these stories told with the constellations as illustrations and backdrop would be told over and over again.  The people knew those stars and the moon like we know street signs, he said.  Their world revolved around lightness and dark, without artificial light to lead them astray.

I realized then, we all have that longing in us to know and understand the heavens, from ancient people to all of us with our Kindles and smartphones.  We all struggle to make meaning of those bright lights in the distance, beckoning us to wonder what lies in the abyss and the unknown.  What I longed for at 12 is the same thing we all have wanted across millenia– to be able to find our way home in the darkness, and no amount of “Shoulds” can dim the stars.  They are there, as they have been for millions of years, waiting for us to tell our stories.

As National Blog Post Month begins again, I’m trying yet again to find my way back. Unlike the mariners of old, keeping journals, star charts and compasses that helped them differentiate the days on dark seas, navigating their way home by the constellations, I lost my internal compass, stopped writing, and got a little lost as I tend to do.  I am grateful today for the observatories that allow us to grasp for brighter lights on the horizon, for the stars in our world that stay constant, and for those wise people in our life like Socrates, who remind us to keep searching for truth. I hope you enjoy this month’s journey to find it with me.

We visited the Griffith Park Observatory in February,  which is located atop Mount Hollywood, and was featured in the James Dean film Rebel Without a Cause.

 

 

 

 

 

 

 

A Soccer Mom’s Ode to Baseball & Dia de Los Muertos

I planned a post today about All Soul’s Day, a day we celebrate the lives of those we’ve loved who have passed away. Living here in the Southwest, Dia de Los Muertos is big, with festive parades and sugar skull decorations everywhere. Dia de los Muertos, or Day of the Day, is a Mexican holiday celebrated on November 1st and 2nd, honoring the deceased with food, ofrendas, and calavera make-up.  

It also happens to coincide tonight with Game 7 of the World Series, a tied series between the Cleveland Indians, and the underdog favorites, the Chicago Cubs.  Being from Detroit, my team is the Tigers, but I’m a sucker for the underdog, so I’ve been rooting for the Cubs. But tonight of all nights, we had no TV reception.  Though we live in the Southwest, we live in high desert, which means that November has brought cooler temperatures, and the winds were whipping over the mountain, shaking our tiny little antenna beyond its capacity. Like my dad always taught me though, “This is history!” We had to witness this, and so I dragged my husband out to the local pub to watch the game, despite a long day after soccer practice for our little guy.

As I’ve posted before, I’m not an athlete.We don’t watch a lot of sports except when my kids are playing or the Olympics are on.  My son has been playing soccer for 7 years, and I still don’t get what off sides (not even sure this is one word or two) means when the ref calls it.  But I grew up watching baseball, and the 1984 World Series Champions were my Tigers.  I can still remember the faces of the players from Sweet Lou Whitaker to Gibby, and my personal favorites, Alan Trammell and for some reason Darrell Evans. Hot Sunday afternoons we sprawled out in front of the TV, fan rotating over all of us ineffectually, or my aunt would pull the antenna up on her stereo to catch the broadcast on WJR by Ernie Harwell.

Tonight, I wanted a little of that baseball magic back.  Watching those games made time stand still, and the game tonight did not disappoint.  I don’t know these faces like I knew my Tigers, but I recognized the same intensity in them.  That drive to win, to play at the top of your game, the agony of a strike when the count is down 3 balls, 2 strikes, and it’s the bottom of the inning, it’s still there.  We sat in the pub with complete strangers, our eyes rooted to each swing of the bat, each bounce of the ball across a rainy field, and all of our cheers and groans somehow united us.  One couple, Marshall and Jennifer, happened to be from Illinois, with long generations of die-hard Cubs fans who never had seen the Cubs get this far in the World Series.  Marshall’s grandfather died two years ago at age 88, having never had his lifelong wish to see the Cubs win the World Series fulfilled.  His wife Jennifer rubbed the back of his Cubs shirt as the score tied at 6-6, and we headed into a 10th inning with a rain delay.

I looked around the pub, at the bartenders who were kind enough to stay open past closing time, at the customers wandering in and out to stand, arms folded in front of the television, at the waitstaff expertly whisking away glasses and plates, and thought of all the other baseball fans across the world, sitting like we were, on the edge of our seats, praying and watching, jumping up with every hit, cheering every catch, holding our breaths collectively.  This, then, is what draws people to sports, though we are not all athletes.  This drama, this heightened awareness of each passing second, it makes us feel alive, makes us feel as connected as if we are all related to the players, like me on the sidelines cheering for my little guy kicking that soccer ball towards the goal.

And when the Cubs did win it, hard-fought as we watched with fingers clenched, palms sweating, Marshall raised a glass in honor of his grandfather, as fans all across the world did, for those who have passed, and didn’t get to be here celebrating with us.  We honor our dead by remembering them, by cherishing their memories, by our longing to share moments such as this with them. After the game, we lingered in the pub, savoring the atmosphere charged with the joyous aftermath of victory, then walked out into the darkness, a blessing of rain echoing that on the baseball field, a strangely fitting end to Dia de los Muertos.

 

Adventures at 101 Independence Ave SE

In honor of National Book Lovers Day, I thought I’d share with you the most nerdly adventure a book lover like me could have–a day spent at the largest library in the world, which is located in our own nation’s capital. If you’ve never had the luxury of exploring the Library of Congress, I’ll offer my portrait of a beautiful and wondrous place that could not have existed without one man whose quote all book lovers can identify with:

In Washington D.C. for the day after a phenomenal conference on genetics and genomics where I was representing PAs, I started off the day getting off the Metro at Union Station, and headed to the U.S. Capitol Building, where I had signed up online the night before for a tour at 8:45 am (the earliest available). It’s free, but you must sign up, as the tours tend to fill up fast.  I’ll share the tour of the US Capitol in another blog post (one of those patriotic, sappy ones, so be forewarned now!), but suffice it to say, I was thrilled to see a sign that pointed to a tunnel between the U.S. Capitol and the Library of Congress.

This tunnel, besides the cool factor of travelling underground between two very different buildings, had the advantage of bypassing security (though you have to pass back through security when heading back from the Library of Congress into the Capitol), as well as being literally cooler given the muggy D.C. heat even at that time of day.  For the members of Congress to have the Congressional Research Service which directly serves Congress in such close proximity is likely quite useful.

Besides the sheer beauty of the frescoes and statuary there, the immensity of the Library of Congress and all it encompasses is astonishing.  It is actually 3 large buildings, the Jefferson, Madison, and Adams buildings which are all interconnected (yes, more tunnels!). This is the Great Hall of the Thomas Jefferson Building. Hours could be spent in this part of the library alone.

At any time, numerous exhibits are ongoing at the library including one currently on Gershwin, another on World War I propaganda art, and another on a collection of maps including one of the first of America.  As part of their bible exhibit, which contains 18 from their collection of over 1500 in over 150 languages, I got to see the Gutenberg Bible, pictured here, and the Giant Bible of Mainz. Everyone knows about the Gutenberg Bible and its significance in regards to movable type, but to have it juxtaposed with the Giant Bible of Mainz which was hand lettered, and produced in the same time and place provided a great contrast.  Seeing first-hand the visible guidelines so that those lettering it could write in a straight, neat line, really brought home how time-consuming a process it was. It took the scribe 15 months, ending on my birthday in the year 1453 of all days!

While exploring all the buildings, I came across the U.S. Copyright Office housed on the fourth floor, which I did not know was a department of the Library of Congress. It contains the world’s largest database of copyrighted works and copyright ownership information. In fiscal year 2015, it registered an astounding 443,812 claims to copyright.  So, there are definitely new things under the sun, though many would claim the opposite to be true.  An office where hearings regarding copyright are conducted is imbued with a modern art twist. By some strange chance, I happened to come when no one was present, and I felt a bit like Alice in Wonderland come upon some strange alternate dimension, as its decor was so different from the rest of the library.

In my travels through the basement, I came across hallways lined with card catalogs.  I thought perhaps they had been abandoned for computer records, however, Carl from Engineering soon disabused me of this notion. Apparently, most resources can be found via computer, but they keep the card catalog because not everything has been put into the computer databases, and he still finds researchers standing with drawers open, writing on pull-out wooden shelves in the basement searching for hidden treasures.

I also came across a giant globe, and one of the engineering workers in hard hat stood studying the topographic map for a long time whilst I took a picture of this giant globe.  It allowed me to give a perspective of just how big it was, and the way he stood there just begged to have the picture taken.

There’s an even larger one upstairs on the second floor in the Madison building, but I was told it was in an area of mostly offices, and the woman on the elevator could not tell me what its significance was.  In my very active imagination, I thought that perhaps they had to be separated because the force of gravity between the two massive globes would wreak havoc on mortal beings and delicate instruments betwixt them.  Either that or having 2 globes next to each other wouldn’t be structurally sound, but that seems a rather boring answer if you ask me.

I did my part in rescuing our economy from financial ruin by making sure to visit the gift shop where I had to stop myself from buying a large scarf printed like an old library card, and one of these fun purses made from recycled Reader’s Digests. The children ended up with a keychain globe of precious stones, a parchment set with quill and glass inkwell, and accurate, readable copies of the Constitution, Declaration of Independence, and Bill of Rights.

Lest you think the library is only for adults, the Young Reader’s Center is a cozy set of rooms on the ground floor with the requisite puppet theater, low tables for artwork, a television with DVD player in a small viewing room and a cushy sectional with large bean bags for curling up to read books and listening to Story Time. If I lived nearby, I would come here every day with my children.

Windows everywhere fill the rooms with natural light. There are step stools throughout to reach the upper shelves (so thoughtful, says the short person), with whimsical carved animals like this one.

All this walking began to make me hungry, and thinking I didn’t want to go back out into the heat, then come back in through TSA-like security, I asked if there was a place to eat nearby.  It turns out in the basement of the Madison building (far away from all the books), there was a Dunkin Donuts, Subway, and a small coffee shop, none of which sounded sufficiently adventuresome to me. On the 6th floor of the building, though, I also learned that there was a large cafeteria, which according to another man with a silver hard hat in the basement, “Is excellent. I mean, really outstanding.” So, of course, I had to make my way up to the Madison Café. Unfortunately, the elevators chose that moment to go out of service, so I earned my lunch by climbing up the stairs to the 6th floor. And the man in the hard hat was right. The variety of choices was a vision especially with my stomach growling loudly enough to be embarrassing.  It included a buffet with offerings included deep-fried oysters, stuffed cabbage, a salad bar, 3 different types of soups, numerous desserts including bread pudding, as well as a grill for made-to-order burgers and sandwiches, a sushi bar, an Asian section with phở, udon noodle soup,  a bibimbap bar, and a breakfast food area.  I chose a beef bibimbap with japchae and cucumber kimchi that was surprisingly good for $7.99. The Asian girl serving the food behind the counter ended up with a similar plate behind me in the checkout, so I knew it had to be at least palatable, or at the very least not poisoned. Perhaps it was because I was so famished, but it was, in fact, delicious.

I couldn’t get over the fact that I was eating delicious Korean food in the Library of Congress while sitting looking out over the city, when a church bell from nearby St. Peter’s Catholic Church began to toll in the tower across the way from the library.  It was definitely surreal.  The glowing cylinders in the air aren’t ghosts of presidents past hanging about, just the reflection of the pretty light fixtures in the cafeteria which was decorated also with posters from all over the world, and photographs of children reading.

Thus refueled, I went next to the Moving Image Research Center, where you can view movies, though you have to request it at least 2 weeks in advance as they store most of the films offsite.  They began collecting motion pictures in 1893.  Films are shown and open to the public in the Mary Pickford Theater which is within the Library of Congress itself. Seating is first come, first serve though. It was there that I learned that anyone over the age of 16 could get a library card.  So being the giant book nerd that I am, I had to get my very own Library of Congress card.  I’ve covered up the picture of me grinning like a fool and part of my signature with my Metro card, which I suppose I’ll save until I come back to D.C.

The process to get a library card was surprisingly quick, starting with a line-up to speak to a lady who requested my driver’s license, asked me if I had requested a library card online, and since I had not, directed me to a set of computers where I filled out a form, then went to sit in line to get my picture taken.  The whole process with 2 people in front of me in line took at most 10 minutes, and was much more enjoyable than any visit to the DMV.

Upon leaving, I saw a curious sign and heard Barry Manilow and laughter spilling from the adjacent room.

I peeked inside and saw an incongruous sight–couples waltzing, ranging from young to old, of all different races.  They beckoned me in, saying “Come on in and join us.” So I did.

My only previous exposure to ballroom dancing was a dancing instructor hired for Dana’s 30th birthday party, where I learned that I am awful at following and possibly born with 2 left feet, and resolved at that point to avoid any kind of structured dancing without more instruction.  Well, the more instruction day had apparently arrived, in the form of Dean. I could not tell if he was with the other 2 instructors, one a matter-of-fact early thirty-something Caucasian lady in pants and dancing heeled shoes, and the other a smiling tall African American man in polo shirt and chino, or just really loved ballroom dancing.

Thanks to Dean and his “big step, little, little” and “1, 2, 3, 1, 2, 3” I acquitted myself reasonably well with a “Well done!” from the tall African American man who asked if I’d done this before, and learned the twinkle step and the patty cake. The pictures are somewhat blurry because most of our time was spent dancing, as it should be.  I spent about 30 minutes in this slice of alternate reality, most of it smiling like a crazy person, because who goes ballroom dancing in the Library of Congress? Me, I guess.

Oh, and at the Library, there are also a bunch of books. Stacks and stacks of lovely books–in case you thought I only like libraries for all the other cool stuff. I once worked with a PA, and perhaps he was teasing me, given what he knew about me and my love of libraries, who said that he didn’t see the point of libraries, stating that if he wanted a book, he would just go buy one at the book store.  I sputtered, and tried to articulate all that libraries mean to me, a person who could count the number of books in the house while growing up on 1 hand.  My adventures at 101 Independence Ave SE just confirmed what I knew when I was just a little girl with a library card: Libraries are a portal to another world, a place where magic becomes reality if you can only open yourself up to all the possibilities and knowledge the world has to offer. I’m thankful for libraries, and for a country that believes that knowledge is important enough to preserve for everyone in a place of unsurpassing beauty and wonder.

 

 

 

 

 

 

 

 

 

 

The Inverse Law of Bathrooms & Nighttime Vomiting

My husband is downstairs watching Band of Brothers, Season 25, Episode 36,000,000 of men shooting and shouting at one another, blankets tossed aside as his fever breaks finally from the flu that snuck up on him this morning.  I don’t find this at all relaxing, the profanity and underlying violence of the voices making me flinch as I check his temperature, but perhaps we are both just punchier than usual from lack of sleep. Last night, in the midst of a dream about penguins finding their way home, the sound of 4 sharp bangs dragged me from visions of Antarctica.

“What was that noise?” I whispered to my husband, immediately awake and frightened.

“What, what? What noise?”

Four more bangs in quick succession followed.

“That noise!” I said urgently, nearly pushing him out of bed.  He stumbled out into the hallway, coming back within a few seconds, as I was putting on my robe.  In the darkness, I am less blind than usual, knowing the layout of my own bedroom, but somehow I missed my middle daughter making her way towards our bathroom. She had been the one banging on her own door to signal the end of her vomiting in her doorway and her need for assistance, as her own bathroom was missing not only the toilet, but a working sink as we are in the midst of removing the 80’s funk which permeates our entire bought-in-a-foreclosure home.

I was not great at physics though I was blessed with great teachers and professors.  Physics is a fun science full of demonstrations, and on tests and homework, I had little difficulty, completing calculations and solving equations so long as I stuck to rote memorization.  In real life, however, during physics lab when those principles had to be played out in real time with gravity at work, I usually failed miserably at predicting how the world actually works.

Last night, however, a real-world situation presented itself and I immediately was able to write a new axiom, and though it is based on a single observational study, I offer it up as a truth that I would recommend to anyone as worthy of remembering.  I am calling it The Inverse Law of Bathrooms and Nighttime Vomiting also known as the ILBNV (pretty catchy, right?).

The person farthest from the closest working bathroom will be the most likely to have an episode of nighttime vomiting, and also most likely to expel the entire contents of their dinner the farthest distance in the shortest amount of time.  

Splitting duties, I took care of cleaning up the daughter, who apparently upon evacuating the contents of her stomach immediately felt better.  My husband, bless his heart, cleaned up much of the mess, electing at 3 am to finish the rest in the morning.  I describe my 2 youngest children as one who never stops talking, and one who never stops moving. Having realized quickly that ILBNV was now in play, I moved her downstairs to be nearer to the bathroom.  Once she was tucked in, and after climbing into bed with her, however, she could not wait to begin describing to me in great detail exactly how terrible vomiting feels, smells and sounds.  By the time she finally fell asleep, I was lying in bed wondering if the twinges in my stomach were my imagination prompted by her vivid descriptions, or actually the beginnings of an exception to the ILBNV.  Thankfully, the axiom held true, and I awoke at 6:30 am to find my husband groping his way one-eyed towards the coffee-maker.

On days like this with just a few hours of sleep, knowing I’m facing getting the kids off to school on time, followed by a full load of patients, then Girl Scouts and piano lessons, then dinner, homework, bedtime and clean-up, I try to remind myself that I once couldn’t wait to be a grown-up. Most of the time, it works, and I’m grateful to be living the dream as they say. Having now penned the ILBNV and with my place in physics history now secure, I’m thinking about quitting my day job, once I find where I put those bonbons I’ve been hoarding.  I’ll look for them just as soon as I finish cleaning up the rest of the mess from last night, as the husband is now in no shape to be scrubbing carpets or walls. It’s a glamorous life, but someone has to do it.

This somewhat flattened York peppermint patty found at the bottom of my travel bag is the closest thing to a bonbon I could find. Luckily, it was still delicious.

Today I am grateful for stomach bugs that last only 24 hours, a good sense of humor, and bonbons in all forms!

 

 

 

 

Oenomel

Today I awoke to a symphony of birds outside my window. I’d fallen asleep with the door to my balcony open as it had been uncomfortably warm when I finally got home from the sloping streets of Santa Fe, and though I’d hoped to sleep in, I highly recommend this over the blaring siren call of an alarm clock. Yesterday felt like spring, a day for wearing shorts and strolling to nowhere particular. If you are anything like me, you’re saying, “I can’t believe it’s May already!” My good friends with green thumbs were bemoaning the hail, sleet, snow and rain we got on May 1: “But it’s May Day!” which led me to think of the real meaning of the phrase Mayday. A derivation of the French “Aidez-moi!” which means “help me!”, this international sign of distress was born in 1927, based on an Italian guy’s take on M’aider. This is improper French (take it from someone with entirely too little French retained in my head for the number of French classes in high school and college I’ve taken). To distinguish it from a casual mention in radio chatter of May Day (for which there are any number of celebrations, pagan and Christian) it must be repeated 3 times to be considered a valid distress call. This brings to mind scenes from all kinds of stories in which an incantation or phrase must be said 3 times in order for magic to occur.

Because I love words so much, I have daily deliverings of words of the day and daily prompts regarding words, most of which I read and tuck away in some obscure fold in my brain, but sometimes the confluence of the words makes it feel like there is some greater theme or scheme not obvious to the oblivious like me that demands to be written about. Today’s word of the day is oenomel, which means “something combining strength and sweetness.” The daily prompt when I began writing this post was the word Hope. In my strangely wired brain, a cry of mayday is a signal of hope.  It means we believe that our cry for deliverance from that which threatens us will be answered.  To ask for help is to believe in some small way that someone or something will save us.  Said 3 times, it is an incantation of hope, a belief in a stronger power to come to our aid in times of distress.  And, today, of all days, a day to celebrate mothers and motherhood seemed an appropriate day to celebrate hope.  If you have been blessed as I have been with a mother who has always been able to offer hope and strength in equal measure during times most dire and full of confusion, or with other strong women who stood in a mother’s stead to be present for you, count yourself among those who have always known hope, always known that any maydays would not need to be said 3 times, as the magic of the cry for mother needs only be said once.

Today I wish for you a day filled with birdsong and brightness, a day made for strolling with those you love, and a life in which you can be for others, an oenomel. I am thankful for my mother and all the strong women I’ve been surrounded by. I pray to honor their example.  Happy Mother’s Day to all mothers by every definition of the word, everywhere, from your local dragon mama!

 

 

 

 

 

Swallow It

As I sit here with an ice pack and foot propped up, it occurs to me that the old adage that doctors make the worst patients should be amended to include all medical providers.  In my work, on a daily basis I dispense medical advice that I frequently ignore.  Not because I think I’m ten foot tall and bullet-proof, but because I’m busy running around taking care of other things before I realize that I haven’t had a single thing to drink all day (hence the three kidney stones), or busy running around and not watching where I’m going (hence the three sprained ankles in three years).  Is it any wonder my mother is always admonishing me to slow down?

I am a firm believer in the mind-body connection.  Since I started practicing medicine, I’ve seen what stress can do to our bodies.  Like most women I know, I carry all of my stress in my neck and shoulders, the non-ergonomic office chair and computer set-up, of course, contributing to the problems.  My husband, on the other hand, feels his stress in his stomach, having difficulty eating when he feels stressed out (I wish I had that problem!).  The brain is the most powerful organ in our body with its ability to effect changes which may seem magical to those not confronted with these cases every day.

Though both branches of my family have survived wars and strife, my recognition of PTSD has grown by leaps and bounds through my work with veterans.  Time after time, I am struck by the stories my patients tell of how ill-equipped they were psychologically to deal with what they saw and did.  Many veterans came back from Vietnam or Korea, and stated that they had no problems with “shell-shock” like other veterans they knew, raising families and working steadily at jobs that built this country, until they retired.  Then suddenly, they find themselves experiencing palpitations and sweaty hands in crowds, nightmares/vivid dreams of people and places they have not thought of for years.  They come in genuinely confused, some of them undergoing cardiac testing for these symptoms which make no sense to them.  After years of looking forward and striving for the next thing, retirement affords them space and time to look backwards, and they find their past is catching up with them.

One veteran told me that shortly after he arrived in Vietnam, he spoke to his supervising officer about his doubts that he could deal with all of the death he was seeing.  This was a man whom he respected, a grizzled veteran of many military maneuvers, and so he took the man’s advice to heart.  “Swallow it,” the young soldier was told.  “If you don’t, it will eat you alive, so swallow it, because we don’t have time for it now, and your job is to stay alive.  Just stay alive.”  I am not a psychologist or expert on PTSD, but I found it interesting that the veteran’s main complaint was debilitating stomach pain with extensive gastrointestinal testing over many years which has been negative.

I’ve had other patients come in with complaints of dizziness.  In medicine, a complaint of dizziness needs to be further clarified in order to narrow the differential diagnosis.  My question to patients with dizziness or lightheadedness is usually asking them if they have a sensation of feeling woozy like they are about to pass out, a spinning sensation either of the world spinning or of themselves spinning, or a feeling of being off-balance.  I’ve learned that besides trying to figure out all of the medical reasons for a patient’s symptoms, it is important to ask questions about how the rest of their life is going as this will have an effect on their symptoms.  It never surprises me that the patients who will share that they are feeling lost or confused, will also describe their dizziness as a feeling of being off-balance, often times associated with blurry vision or tunnel vision.  Is it any wonder that those who most feel out of control emotionally have symptoms that mimic having lost sight of where they are going or where the ground is? Some have literally used the words, “I don’t know which way is up.”

The words that people use when describing their symptoms and telling their stories can be revealing.  Perhaps because I love words so much, I think they are important and I try to pay attention to how people describe their pain.  In our training as PAs, we are asked to be very specific in how we document pain.  Some patients will laugh a little at my question, ‘Would you describe the pain as sharp, stabbing, squeezing, pressure, aching, burning or something else?’ but it helps people to find the word that best describes their pain.  As medical providers, we have a lot of experience dealing with pain, and though I cannot truly “feel” their pain, I always feel that if I can help them name it, it will have less power over them.

One method frequently used to help patients categorize their sensation of pain.

As medical providers, sometimes we can be so focused on the disorder, we forget that mind-body connection.  No matter how many times we read the study about how pretending to smile actually improves a person’s mood, we point the arrow from body to mind, and forgot the power the mind has over the body.  One of my most memorable patients during my psych rotation was a woman who had been diagnosed with somatization disorder (which in the DSM-5 has now been replaced with the broader category of somatic symptom disorder in order to “remove the mind-body separation that is implied in DSM-IV”). She reported paralysis and loss of feeling from the waist down, though all testing and imaging was normal, and there was no report or sign of injury or external trauma. She had been there for weeks undergoing test after test before she was moved to the psychiatric ward. Other patients have reported blindness, others deafness. She would speak cheerfully of everything but the broken engagement that had occurred just prior to her hospitalization, that event a black hole into which all memory had vanished. Was it chance that this woman had lost half of her body, her better half perhaps? Or that she was numb, and paralyzed to the point that she could not move forward or backward?

At the time, though, I was in my first rotation in my second year of PA school. My job was only to learn everything I could about somatization disorder which was thought to be very rare in order to prepare a presentation for the rest of those in our consult service, round on this patient every morning, as well as attending to any new consults that came in that day. My job wasn’t to diagnose this woman with heartbreak, though I thought most likely it was true.

As a PA working in cardiology many years later, I would learn about Takotsubo cardiomyopathy aka stress cardiomyopathy or broken heart syndrome, in which the heart muscle function is dramatically affected in approximately 85% of cases by an emotionally or physically stressful event. Patients normally arrive at the hospital with symptoms mimicking a heart attack, including chest pain and difficulty breathing. Actual visualization of the coronary arteries usually reveals no evidence of significant atherosclerotic plaque to explain the dramatic change in the heart’s ability to pump efficiently or the change in the actual shape of the heart muscle itself.  In most instances, the heart muscle function returns to normal by the time of the patient’s discharge (usually within a week).

Called Takotsubo after a Japanese ceramic pot used to trap octupi, this is a dramatic change in the normal shape of the heart (Credit: Circulation 2011; 124)

The more we learn though, the greater distance we put between ourselves and our patients.  We think we learn enough to make a difference, gaining the tools and knowledge to ease suffering and effect cures.  We gather information, nod sympathetically, lay hands on our patients, and dispense knowledge and prescriptions with impunity, doing our best with what we know. Our patients get better, mostly, but sometimes they do not, and we blame ourselves. We want that distance because we want to believe that we can help our patients. We want to believe we do know enough to make a difference. We forget though, we are ourselves human as well. It is a bitter pill to swallow–“Cure thyself!” we are told and tell ourselves, though we no more listen to our own advice than our patients might. We stumble, and curse the ground, and forget that perhaps,  our mind wants us to listen, and slow down. We learn again, what bruising, pain, and heartbreak can do, and in doing so, close the gap between us all again.