Saturday, September 16, 2017

Weekend Poem


The storm wasn’t as bad as originally feared.
When the feral purple spiral bruise
Swirled slowly north on video maps on the TV news
The Gold Coast of the Gulf side relatively spared
The affluent had all fled to landlocked luxury hotels
and drank vodka cranberry cocktails
and Facebooked pictures of their travails
While the “less fortunate” bailed water from mobile homes.
Waded dazed where streets used to be, clutching dead flip phones

Certain people always describe these things as a “blessing”
The way it all “works out in the end”
Anointing dumb luck
With God’s personal touch
While all the rest are just plain fucked

As if God chooses when to tilt
The odds in your favor,
Load the dice and become your savior.
Send down the wind and rain
Flood the plains, wash away your guilt.

It dawns on the privileged
Just before the roast duck is served
(The uncorked wine a rare vintage).
The Patriarch reframes the gilded opulence
As a gift from God, a gentle reminder
To bow our heads, to accept material prominence

Let us pray:
We are all blessed, the patriarch will say
We are blessed indeed
Bless our beautiful beachside home
Bless our talents and skills, our collective health
Bless you all, bless our long sought wealth
And no one deigns to query (like an asshole):
Where was this god when a child was blown to bits in Yemen,
When another was orphaned by the events of 9/11?

The storm will pass, retreat from bayside mansions
(For the rest, the seas remain ever high)
They make a tally of the damage done:
A couple of window screens smashed
Palm fronds scattered across the lush Bermuda grass
Protective canvas torn from the boat lolling in the sun
But the dock itself unharmed, steadied by stanchions.
Let’s post a picture of old dad on a ladder
Look at him, how cute with his hammer
How blessed
Of course I clicked "like"


Sunday, September 10, 2017

Work History

I always find myself asking a new patient what they do or, for the elderly, what they did for work.  All this stuff about heart caths and gallstones and knee scopes and the gout acting up is numbing and disconnecting. Abstract collections of fact.  Case studies in a stack of medical journals.  Where am I?  What is this place?  Why are we in this room together?  Why are we sharing this space?

If you aren't a doctor you wouldn't know exactly what I mean.

The contrived forced intimacy.  One on one, the one way sharing of embarrassing secrets and frailties. Enough of the unmentionables.  Let's discuss something else.  What kind of work did you do when you were younger?  As if knowing Stan ran a hair salon or Sue was a third grade reading teacher would somehow bridge the gap of absurdity that brought us together here in this small room.  Remind me I'm not alone in here, brightly lit, all the gauze and tape, antiseptic steel. Something to interrupt the piercing gaze, to start again to feel.

The old woman snoozed during the initial interview.  A daughter answered all the pertinent questions.  The colitis.  Bedridden.  Recurrent urinary infections.  Confined.  Early dementia. But what did she used to do?  And the old woman heretofore ignored, sprung to life, as if plugged in, visage brightened.  I used to teach Sunday school.  You know my granddaughter says I have squishy skin.  She likes to pinch the skin on my arms between her fingers like this and she says I have squishy skin and I tell everyone I am an old woman with squishy skin.

And just like that her smile faded.  Her eyes went dull and she turned away toward another blank wall.  That was it.  The lady with "decreased skin turgor".  I put my hand on her forearm.  I didn't pinch, just a light gathering of loosening elastic flesh.  I could see what her granddaughter meant.

Sunday, September 3, 2017

Sunday Poem


The elderly woman lie frail and skeletal on the bed
Blankets tented over legs bent like snapped sticks.
All you could see was the top of her head
A neck kinked sideways, mouth agape, transfixed.
Eyes only half closed, but she didn’t seem awake.
A daughter, I presumed, sat pensive in the chair
Unread book in her lap, sudden stirring from a long stare.
The TV was on but without any sound.
They wanted me to have a look at that wound
The daughter nodded, shrugged, she didn’t care,
Resigned, beyond all doubt
Another new shore.
I asked if she wanted to step out
She paused--- no, I’ve seen it all before

We rolled the old woman right side down
Gurgling groaning moans
Burbled up from the layered covers.
Just to be moved----
To be disturbed----
When all you want is to lie interred,
Insentient, to fade into darkness,
Is an intolerable insult, a cosmic injustice.
Movement can be catastrophic
When you’ve found a good position
Just where you are, a grateful attrition,
A mind become un-philosophic.

Her body was withered and light and taut
Like an old mitt left out all winter---  frozen stiff.
Tight, husked, inelastic----
Like molded hard plastic.
She used to speak with her hands, the daughter thought,
A choreographed undulating gestural flow,
Mapping the route of butterflies through a meadow

It was an unstageable sacral ulcer,
A swirl of soft blackish tan like crusted brown mustard
Left uncapped on the counter.    
It squished when probed
Like veering off trail through a bog.
Boots sinking into a tarry muck.
It would all have to be cut.
She felt nothing though;
The flesh sloughing, deadened
Losing ourselves in layers.
There are no prayers.
Our bodies just shed, are surreptitiously lessened.  
Her odor lingered as an epilogue.
The nurse had to turn her head
We breathed through our mouths.
This hole eroding into a body
Boring deeper, into the muscle, into the joints
Death seeping into us here
At our pressure points.

We associate injury with violent impact
Shearing forces, savage speed
Bones break, you bleed
(Crashes are never abstract)
Fateful moments when things collide.
But a pressure sore is an injury gained
From motionless consistency, a heaviness sustained.
There is only so much a body can abide
Time and pressure
Flesh against surface

Soft tissue sandwiched between bed and bony prominence.
The only option becomes acquiescence
A body cannot attain perpetual motion
Cannot forever stay aloft.
Our forward, hopeful inertia always gets spent.
We run out of steam,
We decline, become senescent,
End up supine, we cease to dream.
At the contact points are the stirrings of a long rot.
Flesh pressed, the seconds add up
Maybe an hour before the stressed cells start to fail
You can’t tell at first, a blanching, a light breeze against a sail

At a certain time, we should all be able to float,
To set sail, to just be---
Buoyant, to glide---
To slip into a warm river and drift with the current
A long untroubled easing toward an open sea,
A weightless leisurely ride,
Along an infinite frictionless asymptote

I remember Marco Island after college
Long days at the beach and then, after a nap,
Gathering at a dive called the Tides, for the sunset.
It was happy and good, the young and old,
Live music, people chattering, laughing
Plates clattering, stories being told.
The sun behind us a hot cigarette tip
Starting its ineluctable, imperceptibly slow dip,
The ocean calm and placid, a beckoning blue trap.

I liked best the reckoning just before fusion
A thin sliver of ghostly light between sun and ocean.
Almost daring something (or someone) to slide through.
If I hustled to the horizon I’d just fit
A reckless dive through a closing slit,
For once the inferior arc of the full orb fuses
The vanishing accelerates, but it leaves no bruises
The sun just sinks, loses itself into the deep indigo gloom.
It melts into the vastness, liquefied, subsumed.

Many times I missed the disappearance altogether
Turning away a few minutes to talk or laugh
Or maybe I just had to run to the john.
When I returned and looked west it was gone.
I had missed it,
Time extinguished it,
Vestiges of light faintly holding on
A hint of the glow of another world’s dawn.  

We used to believe the world was flat.
Primitive superstitions
Gods, black cats
Prophetic visions.
We know better now.
We don’t dissolve into One,
Like our perpetually sinking sun
Always to rise on the morrow

At a certain time, may we all drift to this last ledge,
The mass of us floating with ease
Nudged by a warm Gulf breeze.
To fall at the end over the edge,
To leave behind this solid edifice,
And on the precipice,
Our hands begin to unfold, a final rhythmic gesture,
Before the pull of gravity none can resist
And we fall terminally into a deep abyss;
A hurtling escape from time, from pressure.


Saturday, August 19, 2017

Charlottesville Thoughts

I grew up in Massillon, Ohio--- an ethnically and culturally homogeneous small rural town with a foundering manufacturing base. I was raised by a single mother, visited my father in Arizona in the summers. We lived in relative poverty for years after the divorce. We barely scraped by, to be perfectly honest. (We ate a lot of tuna casserole on Wednesday nights). I was always loved and supported but something always felt amiss. I had grandparents and relatives who casually dropped the "N" word at family gatherings. I was told that mixed race children were bad because "they get rejected by both the blacks and whites" as if one needed a certain skin tone for admission to a tribe. My high school was 98% white. I never really had an actual conversation with a black person until medical school.
I was also blessed with a certain unearned, undeserved intelligence. I did well in school and was able to go off to college and then to medical school. Today I am surgeon in Cleveland and 1980's Massillon seems eons ago, and millions of miles away, even though I could drive to my childhood home in less than 90 minutes if I wanted.
But events like the violence and hatefulness demonstrated in #Charlottesville yesterday bring it all rushing back. The notion that White Supremacy is baked into the essence of America cannot be easily dismissed. As Ta-Nehisi Coates has more eloquently stated in his magazine pieces and books, America is built upon the idea of plunder. Plunder of land, of labor, of life by the "more deserving" Anglo-Saxon elite. In this reprehensible worldview only the White Christians of Western European origin are fit for power. For the racists and white nationalists, subjugation of Africans, of Native Americans, of Hispanics, of the non-Protestant religious is not only justifiable but even morally desired for the betterment of all humanity. As Robert E Lee (the man for whom the Alt Right protesters were ostensibly marching to defend yesterday) said: "The blacks are immeasurably better off here than in Africa, morally, physically, and socially. The painful discipline they are undergoing is necessary for their further instruction as a race, and will prepare them, I hope, for better things. How long their servitude may be necessary is known and ordered by a merciful Providence. Their emancipation will sooner result from the mild and melting influences of Christianity than from the storm and tempest of fiery controversy."
Today I live in an ethnically diverse part of Ohio. The majority of my patients are African-American. My colleagues in medicine are Black and Jewish and Asian and Muslim and Hindu. My medical assistant is a strong African American woman who works her ass off and treats my patients with dignity and respect. For all this I am eternally grateful. My life has become far richer with the experience.
It started with medical school, intensified during surgical residency in Chicago and then blossomed here in Cleveland. Something happens to a mind and a body when you are able to escape the arbitrary constraints of provincial narrow-mindedness. There's a wide wide world out there. And the the further you venture out, the more you find that the extent of the world can be found in the heart of your own soul. You never knew the secret was wrapped up inside, that you needn't go far to find it. In sickness, in pain and suffering, we all cry out with similarly pitched wails of protestation. White or Black or Asian, we all suffer. We all are loved. We all err, we all rue lives lost, chances missed, paths neglected. We all have parents who mourn our failings or falls. We all wish we were better, more loving, more understanding. Life for all of humanity is a series of failures. If we are lucky, we rise from bed each morning with the yearning to maybe make things just a little bit better, incrementally. In medicine, the facade falls away and you see people without any of the obfuscatory bullshit. The authenticity available to a physician is the greatest of all privileges. It may have saved my soul, in particular. Too easy it is, in this fallen, inadequate, craven world to succumb to an overwhelming cynicism and despair.
And so today I say, unequivocally, that I denounce in no uncertain terms the UniteTheRight protests in Charlottesville yesterday. It wasn't "both sides". It was one side promulgating the absurdist notion that one's skin color is a marker of human superiority. This "side" has no place in 21st century America. Beneath the relative melanocyte content of your skin, beyond the arbitrary nature of one's parents' provenance, there resides a commonality shared by all the living. We all have had our hearts broken, we all have faced the sudden pre-dawn stifling fear of our own imminent mortality. Life is a shared experience lived through a seemingly singular consciousness. After all these years that's the only thing I have really ever known to be true. All else is up for interpretation......

Sunday, August 13, 2017

Sunday Poem


The experts now say that bowel sounds don’t matter
That tinkling awakening of the gut
Like all timeworn customs, time shatters.
When to feed used to be so open and shut
Whether ileus, post traumatic
We listened first, it was axiomatic

Lightly press the stethoscope for guidance
A gray moon in early dusk
But it’s a hollowed-out husk
Here there is something worse than silence
A conch against your ear
But it’s not the ocean, I fear,
It’s all the air in the world rushing to escape;
Breathe deep, before you suffocate

In dreams I linger here, convinced I hear something stirring
Or is it the bed creaking, the diaphragm shifting on your skin
Absent bowel sounds, absent sin
Or just forgotten?
Where have you gone?
I wake thrashing to a shrill whirring
Of wings beating in the early dawn
All we used to know and have, sadly misbegotten

I didn’t want to proceed until I heard a sign you were alive
You must stay right here under my watchful eye
But now they say those sounds never mattered---
You’re free to go.
In the silent winter I went crunching through the snow
To the edge of the creek and stamped my boots
Until all the thick black ice shattered
There’s so much to see below
Sticks and stones, dead leaves, broken off roots.

What would I do instead?
Fall prone and, against the frozen slab, press my ear?
I’d be afraid of what I might hear
Flat against the snow, a shudder, a rising shiver
The flow of a hidden eternal river
Or worse, a nothingness, the feeble sound of the dead

Sunday, July 30, 2017

Politically Correct or Just Correct?

Recently the staid, establishment surgical journal, Annals of Surgery, attracted some undesirable attention regarding a Presidential Address to the European Surgical Society they published in last month's issue.  The transcribed speech---- "Modern Surgeon: Still a Master of His Trade or Just an OPerator of Medical Equipment? ---by Polish surgeon Marek Krawczyk MD was roundly vilified on Twitter and elsewhere for the alleged crime of only using male pronouns when referring to surgeons.

Following the backlash, Annals took the extraordinary step of retracting the entire piece.  Their statement on the retraction is below:

In an era of expected gender equality and, furthermore, in a medical field (surgery) where women are increasingly closing the disparity gap (for the past 5 years, women have represented 40% of all general surgery residents) the idea that such an august surgical publication would perpetuate gender stereotypes is certainly unacceptable.  But a deeper dive into this episode raises some questions.  

The speech by Dr Krawczyk was a rather lumbering, anodyne review of the relationship between surgical excellence and evolving technology, i.e. can a surgeon be truly great or is greatness contingent on having the right tool at the right time.  He does a pretty standard historical overview of surgical innovation, from the Napoleanic Wars through the era of transplantation and robotics.  His conclusion is what you expect: the truly great surgeons would have been great in any era.  Cue applause at dimly lit hotel conference room in Bucharest.

The j'accuse of the matter is that Dr Krawczyk uses exclusively male pronouns when referring to surgeons in general (i.e. no one can get angry if "he" is used in reference to Dr Starzl or Dr Buchler).  I don't want to get into the minutiae of "micro-aggressions" or the "violence of discourse" but we can all certainly agree that using "he" or "him" every time to refer to "surgeon in general" is belittling and crude, especially when potentially half the audience identifies with the other gender.  It trivializes and diminishes the actual role that women play in modern surgery.

So does Dr Krawczyk actually do this?  

Well, for starters, the title of the piece is absolutely garbage.  How that slipped by the editors of Annals is head scratching.  Simply substituting one word would render much of the controversy moot.  How does this sound:  "Modern Surgeon: Master of the Trade or Just an Operator of Medical Equipment".  Better?  Less demeaning?  More inclusive?  

How about the body of the piece?  In how many instances does Dr Krawczyk flout acceptable pronoun norms?  To find out I went through the speech and counted.  (I'm a ridiculous OCD bastard when it comes to things like this.)  And I found 5 pretty clear cut instances when "him" or "he" is used to refer to a non-specific surgeon.  I also found 22 instances when he uses a term like "surgeon" (i.e. "surgeon's errors" or "assessment of surgeon performance" or "when a surgeon uses laparoscopy") instead of using "him" or "he".  He even uses the unwieldy "his or her" one time!  I mean, if Dr Krawczyk really wanted to be a cartoonish incarnation of misogyny he could have done so in a far more ostentatious and obnoxious manner.  

Further, Dr Krawczyk, in a response to Annals editor Dr Keith Lillemoe, averred that he meant no gender offense, that in Polish, the pronoun he used is gender neutral and can refer to men and women.  Apparently this was not good enough for Dr Lillemoe and, in a statement to RetractionWatch, he said:
In Polish, ‘his’ is not a gender specific term, but it is in this country, and we wanted to make it right….We didn’t want to make the suggestion that we were not sensitive to gender issues, so we wanted to jump on it quickly.
Well ok.  And jump on it, they did, retracting the piece 3 days after initial publication. That's fine I guess.  But I sort of feel bad for Dr Krawczyk.  His transgression, such as it was, seems to have been amplified by the translation process.  Retraction is one of the worst things that can happen to a scientist or researcher.  The stigma attached to having had a paper or piece retracted by a reputable medical or scientific journal can pollute a hard earned reputation and compromise future attempts to get papers published.

And so now Dr Kramczyk is known by those in the international surgical community with cursory knowledge of the whole affair as that Euro-surgeon who had an article retracted from Annals because of "gender insensitivity".  It doesn't seem fair.  Is he a misogynist?  Or just syntactically challenged?  Or perhaps neither?

Instead of going straight to DEFCON 2 and retracting the piece, perhaps the editorial staff of Annals could have simply taken down the on-line version for the 47 minutes or so that it would have taken to clean up the title and switched out a couple of the "he" and "hims" for "a surgeon" or "his/her" and then posted an explanation for why it was altered.  I don't know, that's just me.

The corrected version remains unposted at Annals.

Sunday Poem

Sound is a Wave

Love is when everything seems to fit,
To slide together with a locking click.
I remember that sound from long ago,
But it dulls and deadens,
It’s clear for just a few seconds,
Soundless action on the other side of a window.

I whisper I love you in the morning with the lights off
While you’re sleeping---
My voice hoarse, halting;  as if I’d been weeping---
Might as well have been a cough

We don’t feel safe without those clicks.
We don’t know if the latch really fits.
Pressing harder is ineffectual
Pull it out, jam it in: futile forced ritual
Let it relax----
Or maybe just give it some more slack.

These little assurances are found lacking---
These sounds, these gurgling forest brooks.
An unexpected silence is menacing and grim;
A suddenly quiet pool where the children swim,
The cessation of splashing and waves lapping
Jolts us from our books.

Underwater is the sound of my own beating heart.
I used to hold my breath as long as I could and listen,
The surface world muffled and dulled and distant.
I never wanted to return---
But my chest tightened and burned
And I shot upward like a dart

If you drop your ring in the deep end I’ll find it.
It will strike the bottom with a tiny click.
Sound is a wave that travels to my heart.
I will find it in the deep dark
I will close my eyes and find it quick