Reflections in a Head Mirror

It is not enough to be busy; so are the ants. The question is: what are we busy about?
-Henry David Thoreau  


The man staring intently at a newspaper vending machine grabbed my attention. He was bent over, reading through the plastic door. As I guided my shopping cart around him, he barely shifted his stance. Clearly, he was very interested in whatever was on the front page of the Wall Street Journal.  

We were staying on the Florida panhandle for spring break and I had just finished the week’s final run to the grocery store. A few final items, a trip through the express lane, and then back to the beach. In a day or two, we would be home again and back to work and school.  

The man at the vending machine must have just arrived in Florida for his own family vacation. His shorts were still pressed. His T-shirt was clean. His skin was still pale and his shopping basket held large containers of sunscreen and some inflatable toys. The little girl yanking on his arm still had price tags on her new sunglasses and plastic pail. Daddy, she ordered, Let’s go! Now! Please!  

Buddy, I know your pain, I thought to myself.  

Here was another person having trouble leaving work behind. In the run-up to being out of town, I had spent many extra hours seeing patients in clinic, adding urgent surgical cases onto the schedule, and hammering through the pile of paperwork that had accumulated on my desk. By the time we had gotten in the car to drive from Wisconsin to Florida, I had been frazzled. It had taken me a few days to reset.

As I watched the man, I realized that I was not alone.  

I drove back to the place we were staying and unpacked the groceries. The beach beckoned but so did the computer.  

I reached for the laptop power switch just as the cell phone rang. Daddy, where are you? Did you get everything? We’re waiting for you on the beach!  

I froze for a second. Then, remembering the poor guy at the grocery store, I grabbed the cooler and headed out the door. 

... [Former Delta pilot] Bill Mazzone, who flew jet airliners for 23 years, said it’s just as possible they got caught napping. "It’s kind of like being in an operating room. You know the physicians and the nurses…are listening to music, telling jokes, they’re doing what keeps them alert," he said. "Things are happening that if the public knew about it, they wouldn’t understand it, but it’s done. They’ve got the same thing in the cockpit."
- Associated Press story, "Could Letting Pilots Take a Nap Make Flying Safer?"  which appeared after a Northwest Airlines flight missed Minneapolis. (Published 10-24-2009)


When I was in medical school many years ago, I was assigned to a surgical service that also had two first-year surgical residents known as "the interns." As a medical student, I was required to stay in the hospital every few nights to help one of them.

Internship was very demanding. The young, newly minted physicians were exhausted from being on-call every other night. Much of the night work was of no educational benefit. Each lab and X-ray report needed to be tracked down from a different corner of the building. All night long, they walked all over the hospital preparing for morning rounds. Just when the interns thought their work was completed, they would get called by the Emergency Room or the floor to see a patient, start an IV, replace a urinary catheter, draw blood, or disimpact a rectum (don’t ask). As the interns stumbled through their assigned tasks the next day, one of the senior physicians would invariably tell them how much easier things had gotten over the years. At the time, I remember dreading my own upcoming internship.

One day after a particularly difficult night of call, one of our interns was standing across the operating room table from me. We were both holding retractors as one of the attending surgeons worked deep in the abdomen. I held a long, curved metal retractor that pulled the liver up and out of the way; the intern held a broad, flat metal instrument to retract the stomach. No talking or extraneous noise was tolerated so we stood silently, leaning slightly backwards — still as posts — hoping to avoid attracting attention. Neither of us could see what the surgeon was doing.

The case dragged on for a long time. I glanced up at the intern and noticed that his eyelids were getting very heavy. Suddenly, he fell over backwards, crashing into a rolling table full of instruments as he headed to the floor. The retractor in his hands flew up and landed with a clang clear across the room. Total chaos ensued.  

Within moments, the intern was sent to the lounge. I don’t think he ever scrubbed in with that particular surgeon again, and I am pretty certain he ended up in ophthalmology.

When I ran across the pilot’s comments comparing airliner cockpits to operating rooms, I paused for a moment. Yes, both pilots and OR personnel review checklists before we begin. Yes, we do best work when we are relaxed, careful, and attentive. Yes, there is often conversation and music while we work.

But, naps? Um, I don’t think so. Not a good idea.

---

The following is feedback received for this blog: I agree with the analysis and I always objected to this comparison of the Operating room to aviation for the following reasons; Many air planes are a like but no 2 patients are When the pilot is tired a flight is canceled but when nurses have to work a double shift due to a sick call we do not cancel the shift, we go on. An air plane is a mechanical device our patients are not. In a flight events are most of the time predictable but in the operating room they seldom are. So what is similar? thanks - Gaby Cohen I have been a Surgical Tech for 16 years, yes you get tired, but you do everthing you can to keep yourself alert. Granted when you are "just holding retractors" it is difficult. That's when you try to make eye contact with your Circulator to say, "Help, this is very tiring!" Usually they pick up on what you need and start up a small, quiet conversation. To help keep everyone going!!!!!! They may even ask the Doctor if they can turn on some music. Most of the time the Doctor will say sure! The comparison between aviation and operating room work is valid NOT because patients are comparable to airplanes but because the WORK of being vigilant over human life - and the fact that human lives are involved should that responsibility for vigilance be betryed - contains many parallels. Isabel

I wanted a perfect ending. Now I've learned, the hard way, that some poems don't rhyme, and some stories don't have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what's going to happen next. Delicious Ambiguity.
-Gilda Radner


Several years ago, we attended Milwaukee Irish Fest, the annual musical and cultural experience of everything even remotely Irish. While wandering the grounds, we discovered the band, Schooner Fare, a trio of singer-songwriters from Maine that captivated us with their tight harmonies, their musicianship and their enthusiasm. It was a great show.  

After the performance, we bought a CD and made our way to the tables outside of the stage where the singers were signing autographs. We reached the front of the line.  

As we greeted the performers, I was appalled. Two of the three were smoking cigarettes. “You depend on your voices to make your livings!” I heard myself saying. “I take care of people with throat cancer. What are you thinking?” 

I do not remember their responses, although they acknowledged that they knew the habit was bad. I quickly wondered if I had overstepped my bounds. I thanked them and left.  

For a few years after that, Schooner Fare continued to perform at Irish Fest and we continued to sit in the audience and cheer. Then, suddenly, they were no longer on the schedule. It turned out that bass player and singer Tom Rowe had developed throat cancer and died while receiving chemotherapy at age 53.  

I still think of him as a talented songwriter, a confident and energetic performer, and a crowd-pleasing musician. He had a versatile and expressive voice. For me, it remains eerie that this person, whose talents I truly enjoyed, was taken by the kind of cancer I have spent my career battling. The day he died, the outside world crowded close to my professional world in a new and uncomfortable way.

Tom Rowe’s death still saddens me whenever I listen to one of his rollicking bass lines or hear him harmonize on one of the band’s albums. I still wish that there had been something I might have said to him on that day, long ago, that would have made a difference.

---

The following are comments received for this blog:

I work at Ft. Detrick in Fredrick Maryland, half of the base is used by the National Cancer Research Institute. As I go across the base I see little knots of cancer researchers puffing away. Every one of them thinks they will stop one cigarette short of cancer.

- Mark A.

The folks at Milwaukee Irish Fest have told me that Schooner Fare (without Tom Rowe) will appear again this coming year. See you there the weekend of August 20, 2010!

- Bruce Campbell

A woman has the age she deserves.
-Coco Chanel
    

She sweeps into the office with a flourish, filling the place with her commanding personality. Because she can be curt, some of the staff members avoid her. She usually refuses to step on the scale to have her weight checked and reveals her septagenarian status only with reluctance.  

Long ago, I recognized her as being “old school” since I have known other women of a certain vintage who were outspoken and uncommonly crusty. She reminds me of a few of my parents’ friends who engaged confidently and forcefully in every social interaction. She remains stylish, if a bit dated, and is fond of expensive perfume.   

Her office visits have never been complicated. Her cancer was successfully removed with a surgical procedure over five years before and, except for some scar tissue and dryness, she has no other problems. She has no difficulty talking and she remains cancer free. Everything, from my point of view, is perfect. She is one of my “saves,” someone who had been cured of cancer with one of my surgical procedures.  

“Everything looks fine, Mrs. Anderson,” I told her at one of her visits. “You are doing great! No sign of the cancer. There is nothing worrisome.”  

She glares at me. “Nothing, eh? I would NEVER have another surgery! Never!” She continues. “This life is terrible! Why can’t you do something about the dryness? Why does my tongue feel so tight all of the time?”  

“Oh,” I think.  

“And another thing! Why does my tongue burn so much when I eat Mexican food? I used to love spicy foods, but I can barely tolerate them anymore! Oh, this is terrible!”  

So it goes. I try to explain the mucosal changes. Scar tissue is less flexible. The linings are thin and sensitive. Things are never the same.

She is not satisfied.  

As she gets up to leave, I find myself apologizing. “I wish things were different,” I say. "See you next year?"  

“I'll call when I'm ready to come back," She turns as she reaches the door and tosses me a patronizing look. “Oh, it’s OK, I suppose,” she decides. "I know you did your best.” Then she gathers herself up and heads down the hall.

---

The following is feedback received for this blog: I love older people; one day I want to be one ... in fact, one day I want to be one just like this! - Jabulani Congrats on the save. That must feel so good. sounds like she enjoys complaining... but underneath it all appreciates that you saved her life. It must be frustrating to have some of her concerns. I'm the polar opposite of that. My Mother spoke what she thought and could come across hard. when she really was not that way inside. years a go when my firstborn was a baby, I decided to sell cosmetics for Mary Kay so I could make my own hours, have an income but choose the time I could be with my baby. They had a saying in reference to having a skin care program... that I still abide by today..although now with a different company. At 20...you have the skin you've inherited. At 40... you have the skin you've made. And at 60... you have the skin you deserve. - SeaSpray seaspray-itsawonderfullife.blogspot.com