A Twinkling Metaphor for the Path Towards Health 2.0

In my ongoing stream of consciousness about art and medicine a new connection has worked its way to the surface. Medicine it seems, is in a state of flux, a state of change and evolution. The hubbub about this is alive in Twitter feeds and on many physicians’ blog sites. The dialog has been centered on the role of media in healthcare, of the use of the internet in patient care, the grooming of new medical students to be our future leaders. The path forward towards the grand new world of health 2.0 is a shifting one with moments of clarity and moments requiring innovation and faith all discussed hotly in the world of social media.

This flux is nicely brought to life in a work of art I recently enjoyed. The artist Charles Sandison produces digital installations of grand physical and philosophical scale. Moving, flowing, changing and in the case of his “Origin of Species”, evolving. This piece is made of points of light swirling around the walls and corners of a darkened room. The lights coalesce at times, into words and form – two words at a time –  the entire text of Darwin’s manuscript on evolution. As words meet each other they form the next words in an unscripted display that will take two years to be completed.

when the word man meets the word woman, the word child is produced; and when man or woman bumps into the word threat, the word dead replaces them ~ Ken Johnson

This seems a fine metaphor for our collective musings on the path forward for medicine. The lights in our heads form words that meet in the blogosphere to merge and change into the next iteration of ideas. This forward progress may take some time but – won’t it be great to watch? I would love to see what Sandison would come up with to display our collective efforts as we evolve.

Perhaps on the wall of lights that describe healthcare 2.0 in words two by two we would see that:

“social” and “media” will merge into “expected”

“empowered” and “patient” will merge into “reality”

“work” and “balance” will merge into “obvious”

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On Turned Exam Tables

I was asked recently by work to write an article for a newsletter about physicians’ experiences with illness. My response to this request was to say that I have been trying to write this very article for a few months and through my efforts I have experienced a new “illness”. It is apparently, quite a powerful one and has had me in its grip for some months now. Its name is writer’s block.

Tonight though, relief has come – in the nick of time. I was reading a NY Times article about a minimalist sculptor Carl Andre. It was entitled “Less is Less” which set me thinking. I started a blog site to challenge myself to improve my writing, to practice writing and to observe myself in the role of writer. One observation to date has been about how story ideas come to me – usually by an odd trickling of input from multiple sources coalescing together to form a lit-light bulb moment of “Aha!” and then, out it flows. No different today. After weeks of struggling with what message to write about from my way too many experiences on the other side of the examination table, that title “Less is Less” did it.

Less is less? Huh? What? I thought less was more. Exactly! That’s it! Every time I began to write about my experiences with being on the other side of the exam table over the last few years, I had too much to tell. I, doctor come patient, tried telling all the stories and giving all the advice I could. But that was too daunting. Instead I find myself thinking, when telling a story, sometimes less is more and,  in the world of forming a bond with your patients? Less is definitely less.

Five years ago, I ruptured my appendix while on vacation in Hawaii. When I made it back to the mainland I faced surgery and a week-long hospital stay. Being the patient it turns out, really is hell. And the worst? The worst was that easily 75% of the people involved in my care did not introduce themselves, leaving me to feel lonely and objectified. From the phlebotomists and radiology technicians who worked without verbal identification, to some nurse and doctors. Yes, doctors. After the initial ED doctor took his history, the nurse gave me some blessed pain relief and the CT was done I waited. And, waited. Then, suddenly into my room burst a young resident who abruptly leaned his forearms on my the rails of my gurney (ouch) and said “So! You have an appy!”. I was tired and in pain so forgive me when I tell you that I looked at him and said in my best attending voice, “I am Dr. Land. And, who the heck are you?”.

This spring I managed to tear all of the hamstring tendons off my pelvis. The repair for that gave me the chance for another stay in the hospital. What a difference five years have made in the quality of care! Every single person introduced themselves and explained why they were with me. They spoke in terms anyone would understand. From the nurses and technicians to the people cleaning my room and the doctors. Yes, the doctors.

This is where more was so clearly more. At my first meeting with my surgeon he entered the room with hand held out, eyes on mine and a calm smile. He sat.  He began by asking about me, about my family, about my job. He cared! He went through my chart in careful detail – family history, medical history, medication list cleanup…. all for my hamstring tendons. I was left feeling that if he cared to take the time to hear about my children and my job, if he cared that my mother and father both had lymphoma, that I no longer take Prilosec then – Wow! He must care about me and he must be a very detailed and thorough surgeon. At my first post-op appointment he asked first how I felt. How was I handling the long weeks of braces and crutches and being non-weight bearing? Then he asked how my daughter was recovering from her  appendectomy (that last bit falls under the category of “when it rains it pours”). Only then after these kind moments, did he dive into what he was there to accomplish.

I learned much from these two times on the patient side of the exam table. Overtly stated, when we as physicians begin properly the rest falls into place. Start with a slow, calm, eye-held introduction. Get to know the person you are with. Then, proceed forward in your work as their doctor. From this beginning success will follow.

Understanding the Family: the power of a careful social history

Perhaps it is my week to be inspired by others blog posts. In the post Do You Like Your Pediatrician? Yolanda MD comments on the importance of forming an emotional connection with patients. After the first visit to her baby’s pediatrician she felt ambivalent about the experience because the doctor did not:

ask any personal questions to get a sense of who we were as a family. … I would expect that knowing the social context of a new patient is an important step to building rapport.

Recently a colleague of mine retired. When I joined the practice 11 years ago he took me under his wing. We are both athletes at heart and love to see patients who are athletic themselves.  Sports injuries were fun for both of us; he taught me lots about broken bones, sprains and tears. He was emotionally wise as well. It was him I turned to fess up to a third not-so-well timed pregnancy. I had just been hired and was fearful of being let go after a trial period so I hid in a too-large white lab coat until I was 20 weeks along.  Then one afternoon I screwed up my courage and sat in his office.

I, um, have something to tell you….

Now I can still remember my sense of peace and confidence when he simply smiled and warmly said his congratulations.

When he was close to leaving our office this winter I battled my own sense of loss by asking two things of him. I asked to have him refer those patient-athletes to my practice and I asked for some of that emotional wisdom. Specifically I asked him for his advice for bonding with the difficult to win over parents and patients. How did he handle the hard to convince or the distant families?

It is likely many a young pediatrician is caught up by the same struggle. My friend’s answer was a simple one. Slow down and really get to know the family as a whole. Ask about their lives outside of our office. Be sure you know what they do, where they live, what motivates them.

This was easy advice to follow with parents that I had a natural affinity for, less so for the ones that challenged me. But, by focusing on his wisdom I have learned to not take it personally when a particularly overbearing mother asks for yet another unneeded lab test; I now know that she had a sister die of lymphoma. I understand that one child who returns again and again for very small issues has both parents newly out of work, they are seeking control of something in their lives. One seemingly aloof mother that puzzled me became clearer when I began to understand more about her marital struggles.

Indeed, “knowing the social context of a new patient is an important step to building rapport”. In fact, it is crucial and the gift of better understanding our patient’s families is a gift worth working to receive.

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Inspiration (or how to break the silence of a slump)

At times I want to write and find my muse quiet. At times I have ideas but no talent. I am learning the solution: when struggling to write – read. I find that as I read newspaper articles, others blog posts, books (more and more non-fiction these days) ideas come to me. From somewhere deep in my brain nuggets of ideas from here, or there, from this source or that, bubble up and coalesce. Then often without real planning, I sit to capture the ideas and the threads that connect them and out flows (at last) a more or less coherent piece. It isn’t that I am borrowing other writer’s work (a friend ask if it wasn’t hard to be so moved by other writing that I actually more or less copied the author’s words or style). Instead, when reading I try to think beyond the words on the page to the connections in my own experience. I find inspiration not an example to follow.

The man who does not read has no advantage over the man who cannot read.

-Mark Twain

What you are today and what you will be in five years depends on two things: the people you meet and the books you read.

-Twila Tharp

I’m off to read.

Language Matters

Language matters. The words we choose can have far-reaching impact on those we interact with. This is arguably more true in medicine than in any other field.

Ryan Madanick wrote a recent blog post on the use of descriptor terms used by physicians in patient’s charts. He felt that the use of phrases like “is a very pleasant 52 y/o woman” or “is an unfortunate 16 y/o boy” is inappropriate. I agree. However, in response to this post one reader commented that he felt Dr. Madanick was nit-picking. He isn’t.

When I see such comments in colleagues’ note I wince. I was taught well by attending physicians who appreciated the power of language. I was taught to leave judgements like “pleasant” and “unfortunate” out of my notes. I was even taught not to use the ubiquitous term “complains of “or complaining of” (as in Mrs. Jones is a 43 y/o woman who complains of stomach pain”). When I was a medical student I had a trauma surgery rotation. The attending during that time was a wonderfully dynamic and caring man. One morning he brought his wife to rounds to listen in (this was pre-HIPAA). Afterwards he asked her what she thought of the experience. She was outraged. Outraged by our use of language. The patients who needed us most were “unfortunate”, “demanding” and “complaining”. Those we liked were “pleasant” and “stoic”. Those we did not were “difficult”. She asked how pleasant, fortunate and stoic we would each be if we were stuck in the trauma unit after a  car accident left us unable to walk or, a bullet to the chest left us struggling to breathe pain-free? She volunteered that it was likely we would all be pretty darned demanding and complaining.

These words aren’t only judgmental and fault-finding, they are dangerous. Dangerous in their tendency to narrow our thinking. I had an experience early on that made this point loud and clear to me. Before seeing a patient one night I was handed the chart by a nurse who asked if I knew the child. I did not. She went on to tell me how difficult the parents were and how the kid was a “frequent-flier”. I glanced at the chart before seeing the child and read a few notes all with comments about this “unfortunate” child and her demanding parents. Several days later I learned that after seeing me, and returning to another physician she eventually presented to the ED in extremis. I sat down alone and went back over my visit. The only error I could find in my care was one of perspective. I entered her room biased. Biased by descriptive words used by the nurse and found in her chart that should not have been used. Did I miss her diagnosis because she was in my office too early in the disease process? Or did I miss it because I was viewing her as a complaining frequent-flier with difficult parents?

When we enter into care for a patient we need to approach them as if they are a tree of possibilities. The choices of diagnosis and the decisions around care should be narrowed not by our own bias and judgment but by careful medical thought. To speak of our patient’s with critical descriptors is not only rude but it is medically dangerous; doing so hurts them, and leaves us at risk as well.

Putting A Name To It

Four years ago my brother-in-law suddenly, and to us unexpectedly, committed suicide. It was a violent and selfish act, devastating in a far-reaching way. He hurt those who loved him, and in unforeseeable ways he hurt even those who did not know him. My children had loved him and were stunned. Their classmates in 6th grade, 3rd grade and kindergarten who did not know him, learned the story from our kids. Imagine! The children in my son’s kindergarten had to learn about suicide far too soon; it was impossible to keep the story silent in our relatively small community. And yet, would silence have been desirable? I think not.

To help my children grieve and to have a designated time to remember his life we have begun a tradition. Each year  our local chapter of The National Alliance on Mental Illness (NAMI) holds a sunflower art contest. The contest is held during the same week he died. We talk about ideas for our entries for weeks then, come together and work, creating individual and group entries. Our neighbors have even joined in. It gives us a set time to personally or collectively, openly or silently think about him.

This year after painting some fabulous flowers, our neighbor Delaney felt stumped. The contest entry asked for a name. What a challenge! Delaney agonized. I suggested that leaving it untitled was acceptable and tried to explain that many of the best artists do just this. But untitled felt, I am guessing, unfinished.

Shortly after I had the good fortune to be walking through a fabulous museum soaking up the art there. The titles kept jumping out at me. Certainly many artists do leave their work untitled but, often an artist is asking us to focus our attention in a direction of their choosing. Richard Wentworth’s room filled with books floating suspended above our heads is named “False Ceiling”. Perhaps a gesture pointing us towards the falseness of the notion that books contain all knowledge in unbiased, unlimited form? At first Tony Cragg‘s sculpture in the Istanbul Modern Museum looks like a study in sinuous, sensuous form. But after reading the title, “Ugly Faces” that is all one can see. Gone is the sexy sculpture, leaving behind just faces in profile. Ugly ones.

Which brings this rubber band story back to my brother-in-law’s death, those kindergarteners, and the efforts of NAMI. By naming the thing in front of us we make it hard to ignore like those “Ugly Faces”. “False Ceiling” became a statement that was hard to stop thinking about. By being comfortable with naming depression we cannot ignore it, we make treatment attainable. NAMI strives to help us put a name to what is all too often right in front of us. To name it allows us to help those who suffer. To leave it untitled allows us to make our own personal and perhaps incorrect interpretations. Wentworth said:

I think I shouldn’t give things titles. I sometimes cringe at it. But it’s like naming the cat. There is something about the act of nomination — sometimes I really love it, like launching a ship.

Sometimes we cringe from naming the suffering in front of us. However, doing so might launch a ship or two…ships of hope.

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Delaney’s painting? It was enthusiastically named “Bust a Bloom” .

A gallery of some of our sunflowers:

The Rothko Story

Let me tell you a tale. A tale of the depth of emotion that art can evoke. A tale that will make you pause. A tale I hope will demonstrate why art history is valuable.

As trite as it sounds, I have a favorite artist, Mark Rothko. And, speaking of trite, I was looking at a You Tube compilation of his work today. At the end were comments, lots of comments. I started to read a few but got hung up on the first one. A comment so glaring for demonstrating the author’s complete lack of understanding of the history behind the art that it catapulted me here to write.

Mark Rothko (1903-1970) was an intelligent and philosophically inclined man who won a scholarship to Yale but left New Haven after two years to join the Manhattan art scene (he was later awarded a degree from Yale). There he began his art education with classes in representational drawing and painting. Ultimately however, he became known for abstract painting and would be placed in the group of artists working in the 1950’s called the Abstract Expressionists. Rothko filled huge canvases with large blocks of vibrant colors.

I paint very large pictures because I want to create a state of intimacy. A large picture is an immediate transaction. It takes you into it.

His technique was novel and refined; he painstakingly applied series of layers of thin washes of colors that added up to creating a luminescence and a remarkable shimmering effect.

Rothko disliked giving up these masterpieces of scale and light and color.

It’s a risky business to send a picture out into the world. How often it must be impaired by the eyes of the unfeeling and the cruelty of the impotent who could extend their affliction universally!

In an attempt to control the fate of his canvases he became famous for exerting control over how they were displayed. They were to be hung so that there was little white wall surrounding them; preferably in a room with only other paintings of his. The paintings were to be hung as low as possible and in quite dim light. He meant the paintings to be  ideally viewed at a distance of only 18 inches so that the (single) viewer would be enveloped by the experience as Rothko had been enveloped while painting them (he wanted to create a feeling that the painting was not static but, continuing to evolve as it was viewed). And, he intended the viewer to have quite the experience. In his fabulous book The Power of Art, Simon Schama says “no other painter in the history of modern art – perhaps in the entire history of painting – was so obsessed with the relationship between the artist and his audience”.  His goal was that we would be transported by his art. Once when a reviewer commented that Rothko was simply a master of color he scathingly responded:

I am not an abstractionist. … I am not interested in the relationship of colour or form or anything else. … I’m interested only in expressing basic human emotions — tragedy, ecstasy, doom and so on — and the fact that a lot of people break down and cry when confronted with my pictures show that I communicate those basic human emotions. … The people who weep before my pictures are having the same religious experience I had when I painted them. And if you, as you say, are moved only by their color relationships, then you miss the point!

In 1958 Rothko was offered an enormous (for the day) retaining fee to produce a set of murals to hang on the walls of the new Four Seasons restaurant in the building designed by architect Mies van de Rohe and owned by the Seagram’s distilling company.  He then rented an old gymnasium and erected scaffolding to model the space at the Four Seasons and began working. In a short time there were dozens of canvases of red, maroon, black, brown and flaming orange. From these he planned to choose the best nine to completely cover the walls all around the main dining. They would thus become more like murals, than individual paintings.

Rothko’s works became sought after, his income soared to 60,000 in 1959 and yet, he mistrusted the wealth that bought his work. Simon Schama explained that Rothko’s fear was having the paintings become “overmantels” or expensive wallpaper for the rich. Perhaps it was this fear that motivated Rothko to go with his wife to the newly completed Four Seasons restaurant one night in the summer of 1959. There they dined amongst the glittering decor, clinking glasses and stylish Manhattanites. There it suddenly be came clear to Rothko that his murals were not meant to hang on those rarefied walls. He felt, likely rightly so, that the diners would not understand his work let alone have the sort of emotional experience he intended for a viewer to have. He turned down the money – approximately $2 million.

Anyone who would eat that kind of food for that kind of money will never look at a painting of mine.

Then followed years of struggle with alcohol and creation of paintings of an progressively dark palette. These  somber paintings seem to represent a final step down into a darkening of spirit. His health failed, his marriage failed and he continued to drink and smoke. He became increasingly depressed.

On February 25th, 1970 Mark Rothko was found dead in his studio, his wrists slit. Hours later on the very same day, a shipment of nine Seagram murals arrived at the Tate Gallery in London to be hung in a room alone according to strict specifications.  Jonathon Jones wrote in a recent blog post for the Guardian that “Rothko was fascinated by the idea of shaping a room with art, using abstract painting as a type of architecture”. He meant to create a physical space where his canvases could work with the surrounding architecture to move viewers to meditate. He meant to induce a religious experience. Upon his death he had created just this.

For dear reader, now that you have heard this tale, you can see that art history is powerful. That an understanding of the history of a work of art can create a heightened appreciation of it. To the uneducated You Tube viewer, Rothko’s paintings may look easy (they are not – remember the groundbreaking layering of pigment he developed and the precision with which he displayed them). To the uninformed viewer they may appear an attempt to generate exorbitant sums of money (they were not– remember his mistrust of wealth and that his constant desire to have the viewer emotionally connected led him to turn down $2 million). So, the moral of this story might be that one should ask about art before you judge. And then with your knowledge, enjoy.

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This is a powerful tale and by telling it to your children over dinner and showing them some of Rothko’s art (try the youtube compilation) you will begin to hook them on the world of art. You may worry about telling them about Rothko’s suicide but then, you could view this part of the tale as a “teachable moment”. It presents to you an open door to start further dinner discussions about depression, addiction and suicide. These are all parts of the world experience that we hope our children avoid. You have a powerful ability to influence their choices if you are willing to discuss these difficult topics. It has been sown that children whose parents frequently talk with them and clearly convey their expectations regarding drug and alcohol use are much less likely to end up abusing substances. Feel your power and start talking. To help here are a few resources.

Balanced Lives – with gratitude

Two weeks ago I sat in an open air cafe in Istanbul lazily eating mezes or appetizers, drinking dubious Turkish wine and talking with my godmother. What a gift! As we sat and chatted the conversation turned where it usually does between two doctors. Boring anyone around us, we always seem to find a way back to the days of our training, trading war stories from the hospital days.

In this case my paltry stories were truly weak compared to hers. Her training was Herculean. She graduated from the University of Virgina medical school sometime in the early 60s as one of two women in her class, did a residency and fellowship in the South Bronx and has just recently retired from a career as a hematologist. Her hours were brutal (every other night for every year), her education never-ending. If every minute out of the hospital is indeed education lost, she lost little. Except sleep. Among lots of riveting tales of patient care challenges, there was one striking personal story. Late in her residency she was at last granted three days off for Christmas. On Christmas Eve she drove from New York to Virginia but became terribly lost on the familiar drive because of a haze of illness setting in. She arrived on her parents’ doorstep at 2 AM exhausted and feverish only to sleep through most of Christmas and drive back to NY the following day. When she returned to work an attending noticed how ill she was and sent her for labs that ultimately revealed mononucleosis. This was thrilling to her – two weeks of enforced time out of the hospital! Who cares how ill she was – there was freedom and sleep before her!

My experiences as a medical student and resident could not have been more different. Although I trained before there was any attention to national limits on resident work hours, I certainly did not have every other call at all, let alone for years. I managed to insert a pregnancy into medical school, one into residency and much to the chagrin of my now-colleagues, one the first year I graduated. I did not have to become ill to find a balance in my life (although I may have been equally sleep deprived thanks to the 3 kiddos).

I just finished reading a thought-provoking post by Doctor Chris Porter. He wrote of the need to shift our mentality or thinking about hours worked in the hospital. He felt it benefits our profession to be accepting of a balance of hours in the hospital (learning more medicine) with hours out (nurturing our families). How true. I am a product of the shifting tide of thought. I am also made very grateful to those pioneering sorts that went before; listening to my godmother talk made me even more acutely aware of the gifts they gave us today.                               ©

 

 

 

 

 

Addendum: Dr. Porter has another wise post on his blog site: On Surgery, “The Part-Time Doctor”. In it he states “Openly planning to balance work life with family life is mature and admirable”. Hear, Hear!

Gifts of Transcendence

I have wonderful friends. Ones who support me and understand me. So, when they heard I was injured and stuck lying around; off my leg for weeks to come, two of the most insightful ones brought me a gift of art. Both went to museums and came back to me with Rothkos. One with a beautiful print and, one with a powerfully written tale of his trip to see a Rothko in my honor. They understand me well.

Some works of art have the ability to transport us emotionally to another plane of experience. Certainly music will do this for most of us. Think of the elevating power of the final movement of Beethoven’s 9th symphony, the Ode to Joy or listen to Pachelbel’s canon. Visual arts too have this power. The Shiva Linga paintings that I discussed in an earlier post are a clear and direct example of this. They were painted as devotional images intended for use during meditation to help the believer focus their prayers. The paintings depict one of the forms of the Hindu god Shiva, the god of destruction and transformation. He  oversees death and rebirth. These paintings therefore are meant to represent transitional space between creation and dissolution.

Despite my not being Hindu or particularly meditative, I found these paintings absolutely compelling. They are simple and repetitive; painted on found scraps of paper by individual, anonymous practitioners. Similar yet interesting in their differences.  As I stared into their central black ovals I felt the world around melting away from behind me while the black space grew to envelope my thoughts.

I have to wonder if Mark Rothko perhaps saw and was influenced by similar paintings. There are parallels to be found in his work: the spare design, simple color blocks and, the intended purpose of transcendence. Rothko meant for us, the viewers stand close to and alone in front of his paintings. He meant for us to be embraced by them. A sensuous, tragic, moving embrace. So now I in possession of my own Rothko’s, feel able to extend beyond the limits of my own experience. I am momentarily lifted beyond the couch and into the enfolding spell that art can provide.         ©

Learning to Sit Still on a Spinning World

When I was first a mom I was astounded on a daily basis by the experience. Not to mention, exhausted. The now 15 y/o then wanted to nurse constantly.  For hours on end, day and night we would sit together – him happily suckling and me? Well, honestly I was bored. There was a certain low-level trapped feeling; a feeling of being stuck yet again sitting tethered to the little creature. Don’t get me wrong, I loved breast-feeding and we made a great team. It did however, take a while to settle into the experience. That settling came when I learned to enjoy those moments of enforced peace.

There is great beauty to sitting absolutely still and giving into the process of nursing. I had to relax and let the world spin around me – the clothes unwashed, the dinner cold, the business of life unattended to. And in those moments of peace I would often think my clearest thoughts.

Again I find myself forced to sit still on a spinning planet. Forced by an injured leg, to let go of the multitasking productivity the working mother in me prizes. My family laughed at me last night as they scurried around on their good legs and I sat on my hurt bum watching them. They laughed because I mentioned that having my hamstring tendon torn is a lot like breastfeeding. Huh? No one stayed around long enough to hear why; but I kept thinking about this idea. My life is so full of mothering and work. So full of electronic medical records, blogging and Twitter. So filled out by friendship. So full that I lack, almost completely, time for quiet reflection. Now, in a space without the ability to scurry I am left sitting and relaxing. A novel experience? No, but one that is nice to return to.

I am reading Twila Tharp’s book The Creative Habit. She has taught me much about my own developing creative habit. One of the first chapters talks about the squelching effect on creativity of background noise. Noise both literal and figurative. She suggests turning off our computers, our music and skipping the newspaper for a period of time to understand the effect they have on us. That was hard advice to swallow; I have always worked with music playing. I started to drive my 20 min to and from work without the radio. At first the silence was a bit uncomfortable but as the days passed I found that my mind was productively wandering. Bits and pieces of my days were knitting themselves into coherent stories as I drove quietly along.

Breast feeding, healing and silent driving. Less tweeting, less laundry, simpler dinners. Soon I may be positively Zen-like sitting here watching them all run around. Hopefully I will at least, synthesize a few blog ideas while I watch.

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Highlights From a Year of Art-looking

My muse has been distressingly quiet lately. Sitting here earlier I was wondering if maybe I need a trip to a museum to stir up the creative juices but, alas… no trip in the works at this moment. So, instead I began thinking through the art I have seen or studied in the past year, turning the virtual pages in my mind. It was a good year for travel; a good year for experiencing art. Here are some of the highlights:

  • Ai Weiwei’s Sunflower Seeds This sculpture presented by the conceptual artist was made up of over one hundred million porcelain sunflower seeds. The seeds we handmade by hundreds of artisans working in small workshops in the city of Jingdezhen, China. The exhibit is meant to evoke thoughts of the role of the individual in society, our increasing numbers and the effects of our needs, wants and demands on the world. It is made all that much more meaningful by the recent arrest of Ai Weiwei.
  • Shiva Linga Paintings These were perfectly introduced by Franck Andre Jamme:The thought has often occurred to me that perhaps never in the universal history of painting, have works at once so mysterious and simple, yet so powerful and pure ever been produced – a bit as if, here, man’s genius had been able to assemble almost everything in almost nothing”. The were created as aids to meditation and indeed they are powerfully meditative. While looking at them, I had to wonder if Mark Rothko studied them such are the parallels between his work and these paintings both in simplicity of design and intended purpose.
  • Rivane Neuenschwander: Rain Rains This incredible installation in the New Museum in Manhattan was introduced rather limply as: being “an environment of leaking buckets that are controlled from flooding by a Sisyphean recirculation tended to by museum staff in four-hour cycles”. This description fails. Rain Rains formed what may have been the most for me moving few art-related moments of 2010. The slow leaks of water from suspended metal buckets to matched buckets below, formed a symphony of plonkety-plonk sounds that filled the room and my heart. Perhaps this again begs the question of why certain art moves each of us individually so much. Why was there, for me, such transcendental power in this room of “rain”?
  • Tino Sehgal’s This Progress: Surely this would be on the list made by any NYC art-goer over the last year or so.  As I walked up the ramps in the Guggenheim I was in turn approached by 4 people of increasing age (from about 11 to 65) who walked with me for a level. As we walked we talked. I was asked in turn (increasing  in age and altitude with each question): “what is progress?”, “Is personal choice always good?”, “what is the meaning of the word amateur” and “This is progress?”. I have continued these magical discussions in my mind since.
  • Jennifer Steinkamp’s Rapunzel. I spend much of my time in museums wishing that all good art had a comfortable bench placed right in front of it to facilitate relaxed contemplation. Such seats are rare. Rapunzel  is hung in a stairwell at the Crocker Museum. The steps their form an unusual but restful nook to perch in while watching these enchanting swinging vines; perhaps the best “bench” of the year.
  • The ever-moving ephemeral art of graffiti passing by on trains continues to fascinate me.It even inspired some of my own efforts:

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Fava Beans: Slow, Dangerous and Tasty

I am having trouble getting these people I live with to appreciate fava beans. What on earth is their problem? For me, favas have a prodigious quality; they fill me with wonder. This family of mine and a few good friends, seem to think I am a bit screwy.

I plant fava seeds in September, maybe October. The summer crops are finished and pulled out to the compost pile, the winter garden is planted. Most of it is meant to be eaten through the winter; chard, kale, parsley, broccoli, onions and more. But, I fill in wherever possible with fava seeds. They germinate, sprout in the fall then are sort of dormant in the winter as we eat all those cruciferous veggies (my family complains some here also). Then, in the very beginning of spring the fava plants wake up and take off for the sky – easily hitting a height taller than me. Many people plant them as “cover crops”; they are nitrogen-fixing plants and renew the soil, nourish the compost. For this purpose they are plowed them under or composted this time of year. But I wait. Wait until those pods are hugely pregnant with beans. Then some random day in May I recruit helpers to haul out the plants and find all the pods (they are by then about 9 in long and swollen with about 6-8 beans). We then take the pods into the house and begin shucking them, forming more compost and a surprisingly small pile of beans. These beans are next briefly dipped into boiling water to blanch them and loosen their skins. After diving them into an ice bath I start shucking each bean out of its whitish covering. “I” because by then I have usually lost all my helpers who somehow do not see the beauty of this process.

Then with my shockingly small pile of bright green beans, I can cook dinner. I usually get two meals out of a harvest. My favorite two recipes are a ragout with sausage, favas, tomatoes and papardelle and, mashed favas and mint as a bed for halibut. Both yummy indeed but, both more delightful for the celebration of the passage of the seasons and the miracle of growth. Eating them creates a zen-like experience. It becomes one of those times when you pause, breathe in and really taste the food on your tongue.

Briefly though, there is a danger to eating Favas. People with the X-linked recessive hereditary disease Glucose-6-phosphate dehydrogenase deficiency can develop a fatal hemolytic anemia after eating favas. People of African, Middle Eastern and South Asian descent are affected most often. It could therefore be surprising to hear that favas are most commonly enjoyed in theses very parts of the world. The theory behind this is that the condition of “favism” offers a protection against infection against malaria.

Slow, nourishing, dangerous and tasty… How could you not be awed by these beans? Indeed, it seems one other person around here “gets” them. For mother’s day I was given a poem:

Dear Mom,

You are as exciting as radishes, as pretty as flower.

You are as spicy as peppers and you always have thyme to help me.

You are worth the work like fava beans and as sweet as blackberries.

Worth the work? Me? Hmmm.

Vulnerability, Becoming a Better Doctor and the Beach.

I like to keep a separation between my workday and my home life. It is created by a walk to my car and a 20 minute drive home. During this time I think, create and often, ask myself how I can be a better doctor tomorrow. Lately, I have been thinking the answer lies not in reading more books or journals, timely license renewal or peer review. The answer it seems, lies in feeling my own vulnerability.

I had a patient this week who was perhaps, a bit challenging. I was overloaded, behind, late. She was not doing what her parent and I needed her to do. Frustration started to enter the room but, as I sensed its arrival I stepped back (literally) and looked at my patient. Then, it hit me. She wasn’t trying to be non-cooperative (that horrid, judgmental, doctor term); she was feeling vulnerable. Scared, hurting, feeling… at a loss. Being ill or hurt makes it hard to be brave, strong and – cooperative. The more time we physicians have the “opportunity” to feel this vulnerability, the more we become able to feel what our patients and their families feel.

Maybe I should not take vacations. I seem to end up worse for the wear after many of them. Hawaii the first time found me in preterm labor and complete bed rest at 20 weeks. Scary then, but now he is 15 and perfectly fine. Hawaii again led to a ruptured appendix and way too much time in a hospital bed. Most recently, a sparkling San Diego day disintegrated into an explosion of pain as my skate slipped on a patch of poorly placed sand. I was left immobilized for a handful of weeks and am now facing a ridiculously long period of rehab. Each of these beach-side mishaps left me stranded, forced to slow down and experience the world as many of my patients have had to. I felt acutely vulnerable. Pain. Needles. Limp. Weak. Dependent. All of this bringing to mind an often quoted passage:

“Did you ever say yes to a pleasure? Oh my friends, then you also said yes to all pain. All things are linked, entwined, in love with one another.”

“What does not kill me, makes me stronger.”

– Friedrich Nietzsche

Yes to vacation? Then risk yes to… learning. For I have found during each stint with vulnerability my skills as a physician do become stronger. But maybe on my next trip (in June with my mother and Godmother in a faraway seaside city) I can take a holiday… not just from daily life and work but from learning?

Classic Tales: Pelicans, Pennies and Pain

I am reading a book now that has got me thinking. It is The House on Mango Street. The jacket cover tells me that I ought to find it important; perhaps a classic. A classic? What exactly is one? My sixth grade English teacher snarkily informed us that a classic was just a book our parents had been made to read so they felt compelled to set us to reading. I came home and told my mother (a classics-lover if there ever was one) and I do believe this may have been one of the three times I have seen her really mad). I chatted with a friend the other night about this concept of “classics”. He felt that often a classic was simply a book of overblown reputation. Perhaps he and Mrs. Snarky were on the same page?

I took little english in highschool and none in college. Yes, none. So now I feel at times left out of the dialog. I try to catch up by reading the “classics” that I hear referred to, their names tossed around like ping-pong balls by those in the know. I read Shakespeare when riding the Muni to and from work one winter. Read all of Jane Austen at some point. I devoured Anna Karenina and The Age of Innocence kept me awake until 2 AM when I reached the horribly frustrating ending. I read classics to understand what all the hoopla is about; to be on the collective conversation. It seems to me that usually the classics are dubbed such for a reason. They are classic indeed.

The style of The House at Mango Street is interesting. It is written in very small chunks. Disjointed chapters with tantalizing titles telling, piece by piece the story of a girl’s youth in a poor Chicago neighborhood. It was a hard read; perhaps I was in the mood for a book with a plot? After one bout of trying to connect with this respected book I lay in the dark thinking about it. Then the magic of it hit me.

I also seem to experience life in disjointed moments of clarity. The days are filled with so much routine that is the punctuation that stands out. Our lives don’t have a plot really, they don’t have the suspense of a good novel. We move through the routine of life from moment of sharp juxtaposition to the next. So a book written in small chunks of observation, is a commentary on our routine lives – small offerings to be pondered and thought about. Bit by bit.

My night-time thoughts proved true in the morning. As I moved through my day it wasn’t the connecting pieces that struck me. Instead I would tell you a tale (much like that unfolding on Mango Street) of small moments. My 9 year old’s joy over finding he could buy a big basket of shells for the scant money left in his pocket.  Laughing at my children as they worked to count every pelican that soared overhead for days after their aunt offered to pay them a penny a pelican. She had no idea how observant they can be! The incredible pain of falling hard when least expecting it. These form the stories of our lives and these stories are often the ones worth considering classic.

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Why Pie?

I have a test question for you. If I spent my Sunday trying to perfect Boston cream pie whose paintings did I enjoy on Saturday?

It was a rainy Saturday so my daughter and I went back to the Crocker Art Museum. The art we soaked up got me thinking and, questioning again. I have asked here “Is THAT art?“, “What IS art?” and “Is graffiti ART?“. Now I am led to ask why did the artist choose that subject; why THAT art?

We saw a broad range of art at the Crocker. First we spent an hour looking at an exhibit by John Buck entitled Iconography. Every strikingly beautiful print was as striking in its capacity to generate thought. They were very large format wood block prints carved with bold designs and filled from top to bottom with intricate details. It was those details that got the discussion flowing. One print was of a bottle filled with carvings depicting the effect of the arrival of the white man on the Native Americans – the deadly cost of our disease and alcohol. Another depicted the environmental price of deforestation and oil drilling.

It was obvious why he chose these topics – they are meaningful, important and compelling.  Another exhibit we saw was less so. It was simply confusing to me why Daniel Douke’s work in the exhibit Bytes of Reality was there. He showed great technical skill in his ultra-realistic paintings of mailing boxes. They seemed to be a cross between Duchamp’s found objects and Warhol’s Brillo boxes. The Crocker’s website states:

By making these discarded boxes art, he gives them permanence and value, challenging our assumptions about reality and artifice.

At the risk of sounding uneducated, I don’t get it. A docent tried to explain the work to me but left me wondering if I was looking at the emperor’s new clothes and feeling that some one was telling me a story already told well enough before. Besides this judgment, my biggest question was this: “WHY mailing boxes”?

Next we entered the permanent collection which includes the works of many California artists. Positioned to the forefront; in the first room is a group of paintings by Wayne Thiebaud. Thiebaud paints with thick brush stokes of vibrant colors; bright white, edges of purple and orange. He depicts scenes of San Francisco’s rollercoaster streets and some central valley landscapes but is most known for desserts. Not deserts, no. Cakes, gumballs, pastries and pie. Boston cream pie to be exact. I love pie and really enjoy his work. It makes me hungry. But that day mixed with my hunger, was that same thought. Why does Thiebaud paint dessert?

Two great artists. One etching monumental works of powerful concept. One painting with mouth-watering precision, pie. Why the pie?

“If the world were a perfect place,” wrote Michael Kimmelman in the New York Times in 2001, “the Wayne Thiebaud retrospective that has just opened at the Whitney Museum would be nailed to the walls for good and we would be free to stop by whenever we needed to remind ourselves what happiness feels like.”

So indeed, some art may just be meant to make us happy.

Now, does anyone have a better recipe for me?

Water to Wine

After spending an afternoon writing a brief article for work about how to discuss and prevent alcohol use in preteens I brought the topic up at dinner. The responses from the two preteens present were gratifying (whew!). I asked them why they think some kids try alcohol. The 11 y/o said simply “stupid peer pressure”. The 9 y/o said simply and emphatically “ew!”. The 14 y/o was not there but, the discussion reminded me of a similar chat we had with him years ago.

We were sitting around the dinner table with another couple and their child. The two boys were probably about 7. Somehow the topic of drinking alcohol came up and my son asked why grownups were allowed to drink but kids weren’t. This is a good question that your preteen may ask you if you open this topic up at the table tonight. The societal messages around drinking can be confusing for kids. We tell them they can’t drink until 21. However, many people seem to think that alcohol use in teens is better than drug use (this despite the scary statistics to the contrary). TV shows, movies and video games can make it look like everyone drinks. That night we explained to the kids that one reason kids are not allowed to drink is that young bodies do not metabolize alcohol the same way as adults. That it is much more dangerous for  a young child. The next morning, my son used this information to point out another mixed message in his world.

It was Sunday and although not always faithful church-goers, we went that morning. Early on in the service there was “discovery time” when the young children come forward for a brief lesson directed at their level from the minister. That morning it happened to be a talk about turning water to wine. The kids were captivated and fascinated when the minister poured plain water ceremoniously into a pitcher (with some powdered purple drink mix hidden on the bottom) and then poured out the “wine” into cups to share with the kids. My child gasped and gave me a mortified look from the front of the church. He then proceeded to run down the aisle, jump into my lap and rather loudly exclaim “He’s trying to kill me Mom”!

Indeed, society promotes alcohol to our children and they find many mixed messages around them but, ministers are usually not in the business of scaring small boys! Your preteen though, is still at an age where he believes in you and your abilities to teach him are miraculous; start talking tonight!

Spring Has a New Name

Sure, every mom does lots of laundry. I too do lots of laundry. It used to really bug me. I would try different systems of managing the endlessness of it. My sister-in-law swears by an only one day a week system. No laundry for 6 days did sound like a dream come true….problem was that the seventh day was hell.

It is the folding that really kills me. I don’t seem to be able to stay on top of it. My best friend suggested her trick: don’t. She hucks the load of clean laundry on her bed and the kids sort through and grab their own stuff and…stuff that in their drawers. My mother was horrified when I tried this; she straightened their drawers and folded every thing in the house for the whole week she visited.

I came to peace with the laundry some time ago. I decided to try a zen-thing with it. Tried to focus on the moment, to feel the cloth as I folded. Enjoyed the peace of the laundry room alone. Started listening to NPR podcasts to get me through. I developed a nifty system of organization in my laundry room. It was, as they say, all good. For a while. Then, spring hit.

Spring came last year and involved one baseball player, one softball player, one lacrosse player, two swimmers, five skiers and a new puppy. Wet towels, muddy pants and smelly socks piling up day after day threatened to take me down the path to insanity. How is a mom supposed to keep up with spring in the laundry room? Well, I think I found an answer. Make that three answers, a boy, a girl and their brother.

Spring has come again. I call it Laundry Season. This time it involves three lacrosse players, two swimmers, the ?dog and five skiers. Yesterday one of them came to me and asked what setting was right for his lacrosse pads. Cool.

Oof!

I am still reading The Creative Habit by Twila Tharp, I am motivated by Doctor_V  but, I still haven’t gotten out of bed before the sun to write. What a struggle this creating a writing habit is. I write for fun, I write for pay, I write to get better at writing but, increasingly it is hard to carve the time to get the job done.

The kids interrupt. The “dog” barks. The cell phone rings. The house phone rings. I ought to exercise. My hair grew. The garden grew. My neighbor is all kinds of fun. All kinds of excuses. But dear reader, the biggest distraction is this computer! Email (on 4 different accounts, don’t ask), Facebook, Twitter. The NYTimes and LATimes on-line. Love Wikipedia! Need to check to see if I have comments here to respond to. How many people looked at my blog today?…  Oof! How, when we write for a living on the computer, do we turn it off to write?

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The “Dog”. What is your theory?

Late one night in January last year the kids came running in the front door thrilled with a fuzzy new find. Percy was an abandoned, dirty, matted and very hungry 2 month old puppy of indeterminate breed.  We tried all the usual channels but, no one ever claimed him. Puppies, it turns out, are a bit of work. We (read that as: the grownups in the house) were thrown into a cycle of late night runs for the backyard and endless rainy walks saying (on the advice of a well-respected puppy trainer) “Do it, Percy, Do it” to train him to defecate on command.  As if. I started searching for recipes that would separate the meat from all that hair. No luck. It has since then been pointed out to me that I did not actually have to keep the critter that perhaps, I should have told my three beaming children “No”. Right. You try.

Everyone likes to give us their theories about  what exactly, he is. Portuguese water dog? Something-a-doodle? Bijon frise? The cat thinks he is a cat. He thinks he is …comfortable here.

 

 

 

 

 

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