Sunday, October 19, 2008

Blogging as a Way to Quench the Fire

Write as if you were dying. At the same time, assume you write for an audience consisting solely of terminal patients. That is, after all, the case.
-Annie Dillard

There are days when I just cannot wait to pull out the laptop and begin working though a new topic for an essay or blog entry. The urge to write is unpredictable; I might hear a story, read an essay, or bump into an idea during a conversation. The urge forces me to confront and wrestle with the new concept until I have made it my own.

I always blamed this urge on my suspicion that I have at least a little Obsessive Compulsive Disorder within. A better (or, at least, alternate) explanation emerges from a recent interview with Poetry Magazine publisher, Christian Wiman. Mr. Wiman talks about how the writer (in his case, the poet) finds relief only when he or she completes the work:

“If you have that particular fire in your head (to paraphrase Yeats), it’s going to play practical havoc with your life. It’s going to require a lot of the emotional energy that you might be giving to other people, it’s going to afflict you at odd and unpredictable times, and it’s going to afford no compensation except for the sweet relief you feel when, as a poem finds its form, that fire goes out. What a relief that is, though, and how close to the very center of being itself you can feel at that moment.”

Despite my amateur status in the writing world, I have known the anxiety of an undeveloped thought. Now I also know that I am not alone.

Wednesday, October 15, 2008

"Please Hang Up and Dial 9-1-1"

How we spend our days is, of course, how we spend our lives.

-Annie Dillard

I spend hours and hours each week waiting.

I wait for computers to boot up. I wait for computer screens to load. I wait for programs to ask for and accept my user name and password for the umpteenth time so I can view a CT scan and then re-enter a different user name and password to retrieve the patient's phone number. I stay near phones and wait for people to return pages.

I know, I know...not everything can be instantaneous. There are millions of electronic baby steps that need to be repeated each time I complete typing in my password and hit “Enter.” Maybe someday, my son, the computer engineer, will solve that one.

However, there are things that make me wait that seem completely unnecessary. Consider the phrases below that you each have heard (and waited through) thousands of times:

“Thank you for calling Dr. Bob’s office.”

(I suppose that phrase is okay. It’s nice to know that I reached the correct number. And that they are polite.)

"Our regular business hours are 8:00 to 4:30 Monday through Friday."

(I check my watch, knowing full well it is 10:00 a.m. on Thursday.)

"If you are hearing this message during business hours, it means we can’t get to the phone right now."


“If this is a medical emergency, please hang up and dial 9-1-1."

(How stupid do they think I am? “I’m bleeding to death here!!! Any quick advice??? Can you squeeze me in today and sew my arm back on??? Gawd, I hope you are taking these calls in the order they were received!!!”)

“If you know your party’s extension, you can enter it at any time.”

(If I knew their extension, whether they are at a party or in their office, I wouldn’t still be listening to the recording.)

“If you don't know your party's extension or if you have a rotary phone, please stay on the line. We will be with you shortly.”

(Rotary phone??? Are they kidding? Who has a rotary phone? And what if it’s an emergency? Am I supposed to both hang up AND dial 9-1-1 on my rotary phone? While I'm bleeding to death??? I’m so confused…)

“Otherwise leave a message after the tone...”

I once had an administrative assistant who finished her message with, “... and I’ll get back to you at my earliest convenience.” At HER earliest convenience? I asked her to change that.

I wish I could live a whole week where I never had to wait for a computer to boot up, for a password to clear, for a page to load, for an operating room to turn over, for a person to answer a page, or for a recorded message to get to the beep.

Or else I wish I could learn to discover some form of regenerative and meditative peace in those endless delays where my life seems to slip away from me one wasted moment at a time.

Monday, October 13, 2008

Technology in the Wrong Place

Listening is such a simple act. It requires us to be present, and that takes practice.
-Margaret J. Wheatley

A few years ago, I stood in the back of the medical school’s stadium-style lecture hall as a friend spoke to the room full of students. Of the 200 in the audience, maybe a couple of dozen had their laptops open and, from what I could see, few of the screens featured anything relevant to the topic being presented.

This seemed odd to me. These medical students were paying thousands of dollars each semester to be in that room. A world’s expert was in front of them, sharing her passion in a once-in-a-lifetime entertaining encounter covering a subject she knows well and for which she is a gifted instructor. Nevertheless, some of these students had chosen to spend the class time playing games, working on other projects, or checking their email.

A relevant essay appeared this week on the New York Times "Lesson Plans" website. In an essay entitled “Putting Technology in its Place,” high school teacher Matthew Kay writes about competing with his students' laptops in the classroom. The students “…struggle against the frequent distractions popping into their view. Not long ago, students would ball up scraps of notebook paper and pass them around the room. They now instant message three friends at once. Boys would tuck copies of Sports Illustrated under their textbooks — now they open another tab at” He notes that “[t]he sternest words in my arsenal are ‘Screens Down.’”

Of course, distractions have always been available. I’m certain that the students gathered around the Greek sages of old drifted off by drawing lines in the dirt and finding patterns in the clouds. This seems different, somehow. Does the laptop, by its very nature a connection to “authority,” pose a new level of challenge to the teacher? I fear it does.

Next time I give a lecture, I think I will request “Screens Down” from the outset. And, you there, put your iPhone in your pocket, will ya?

Sunday, October 12, 2008

SurgXperiences 208 is Up at Suture for a Living

A great collection of surgery-related posts is cataloged in SurgXperiences at Suture for a Living. Once again, Dr. Bates does a terrific job of finding, compiling, and explaining.

Thursday, October 9, 2008

A Chill in the Blogosphere

My mother used to say, "He who angers you, conquers you!" But my mother was a saint.
-Elizabeth Kenny

Dr. Wes’s recent hassles with an anonymous blog comment writer gave me flashbacks of two very unfortunate incidents that happened to physicians I have known.

Several years ago, a woman died of cancer and her son blamed the physicians, one of whom happened to be a friend of mine. The son called and screamed at the doctor, threatening her and her family. He knew where the doctor lived and the names of her family members. The doctor and all of us who worked with her were shaken by the experience. One day, a package arrived. Inside, the physician found a body bag like the ones used by mortuaries. Fortunately, time passed and nothing happened. The memory, though, remains.

Another story had a more tragic outcome. Dr. John Kemink was a well-known and respected ear specialist at the University of Michigan. I met Dr. Kemink when I took an ear surgery course in Ann Arbor during my residency and found him to be a friendly person and a terrific teacher. In 1992, an unstable patient became convinced that Dr. Kemink and another physician were conspiring to perform an operation on the patient designed to kill him. The man brought a gun to the hospital and murdered Dr. Kemink in the clinic. It was an incredibly senseless act of violence that the patient apparently viewed as retaliation for a perceived wrong.

No one of us is perfect, of course, and conflicts will always occur. Still, you sure hate to see folks that you respect targeted by angry, unhappy people. It takes a long time for everyone to recover. We're all pulling for you, Dr. Wes.

Friday, October 3, 2008

Things That Wear Me Out

In ascending order, here are the work-related things that have worn me out recently:

Sort of tiring, but exhilarating:

Spending the entire day in the operating room.

Sometimes difficult, but not too bad:

Spending two hours making patient-related phone calls.

Truly tiring:

Spending all day in clinic.

Tiring and also painful:

Spending two hours dictating the charts of the day in clinic.

Absolutely exhausting:

Spending all day teaching six periods of high school health class on the dangers of smoking.

I really respect teachers. How do they do it?