Tuesday, November 27, 2018

M R Swans. C M Wings?

It was 50 degrees and raining steadily when my flight out of Newark International Airport was cancelled for high winds. My aunt and I were an hour from home and still 30 minutes from Newark, so she turned the car around while I called United Airlines and my chief resident. The airline was so backed up that it couldn’t put me another another aircraft until almost 24 hours later. Unfortunately, that meant that another resident had to work my emergency room shift on Tuesday. I was granted an extra day of vacation, and I thoroughly squandered it by sleeping past 8am, going for an hour-long walk in a chilly but beautiful park, and goofing off on my laptop writing blog posts like this one.

This is the Musconetcong River near Hackettstown, NJ, on land once occupied by the Lenape. The park now includes ball fields and paths along the river and the fish hatchery canals, where two swans joined the mallard ducks and Canada geese. I booked this solo trip to visit cousins right after my grandfather’s memorial in Charlotte and the shooting at Tree of Life synagogue in Pittsburgh happened on the same day. Having swapped shifts with a colleague, I discovered I had a 3-day weekend and decided to spend it with family I hadn’t seen in a long while. We traipsed through Princeton’s campus and the Princeton Art Museum, watched football and played games, decorated the Christmas tree, ate pie for breakfast, watched my cousin's kid make an awesome header goal in his last soccer match of the year, and generally caught up with each other’s lives. I’m really glad I made the trip.

p.s.--I hadn't realized I had made the title joke before: see M R Fish. C M Gills?

Sunday, November 25, 2018

Art Potpourri at Princeton University

While visiting my cousins in New Jersey, we spent a very enjoyable hour at the Princeton University Art Museum ogling the variety of their collection. For grownups visiting alone, it could easily take 2 hours or more, but we had two eleven-year-old girls in tow, and their attention spans were just not that long--especially with the prospect of ice cream on the schedule. I was really impressed by the quality and diversity of pieces on display, which the chatty docent who met us at the door told us represented only 10% of their holdings.

On the left is a gorgeous old stained-glass window in the Arts & Crafts style of William Morris, and on the right a contemporary mobile sculpture that undulates sinuously on a timer. Below is "After Vespers," a charming portrait by Lord Leighton Frederic (1871). My poor little cell phone doesn't do the rich oil colors justice. Below that is a delightful sculpture by Jacques Lipchitz of an acrobat on a circus horse (1914). It reminded me of the Ringling Circus Museum that Dear Husband and I saw in Sarasota earlier this year. (Click to see yours truly doing "acrobatics" on horseback!)

The ancient Chinese grave guardian on the left was one of a group of figures that captivated my interest. I had never seen anything like these composite clay statues with horns, scales, fur, claws, wings, and snouts. Next to it is a photo of one of several ancient Greek mosaics with a stunning variety of colors and inventive geometric and nature-inspired shapes. Below is one of several pieces of Native American artwork included in a temporary exhibit on nature in American art. This is wampum made out of quahog clam-shell beads recognizing that the museum is located on lands that used to belong to the Lenape. The symbols are a broken peace pipe, a turtle, a tomahawk, and a cross.

This provocative piece is part painting, part sculpture. Created by Valerie Hegarty, "Fallen Bierstadt" (2007) reimagines Bridal Veil Falls in Yosemite Park as a classic, pristine landscape destroyed by fire and human intrusion. I would love to see so many natural wonders like Yosemite  or Yellowstone, but I worry that I will be one more human trampling on nature, and getting there via fossil-fueled airplane and car, thereby contributing to global warming and nature's destruction. 

Above are images from the Princeton Art Museum's medieval religious collection. Some of the art was hung in a standard, relatively minimalist gallery, while the rest occupied a room with gorgeous stained-glass windows and carved stone columns and "sheep gates" from a cathedral (right). On the left, Andrea Rico de Candia painted "Virgin of the Passion" on the island of Crete in the second half of the 15th century. It combines traditional Byzantine motifs like Mary's facial features and her "showing the way" by pointing to the Christ child with newer ideas like both Greek and Latin inscriptions and what the placard described as a frightened Jesus, losing a sandal as he hurriedly turns to look over his shoulder.

Said ice cream turned out to be delicious at The Bent Spoon, a neat little shop that has dairy-free options. Palmer Square was decorated for Small-Business Saturday, and these three ladies were singing Christmas carols in Victorian outfits. God bless them for their exertions in the cold. After stimulating the local economy, we went home for Rutgers football, take-out from an Asian fusion restaurant, and a rousing game of Forbidden Island. (If you've never played cooperative team games like Forbidden Island or Flash Point, I really recommend them!) Sunday morning we worshipped at a sleepy rural clapboard church before heading off for the next thing (my aunt and uncle's house).

Saturday, November 24, 2018

TSPGH: Robot Repair Shop

Already tickled from having had the time to peruse the "cabinets of curiosities" from the Carnegie Museums, imagine my delight at continuing along the concourse to discover this installation from Western Pennsylvanian artist Tobey Fraley (1980- ). Okay, to be perfectly honest, at first I thought it was a robot-repair shop that hadn't opened for the day yet. Wait, what? Then I recognized the distinctive round robot bodies from a statue at the Children's Hospital of Pittsburgh from when I interviewed three years ago (post and pic here). Fraley had originally made the diorama for a 2011 public art campaign. It came to the airport in 2015 and, just to keep things interesting, he changes things up sometimes. It is "Still the world's only in-airport repair shop!" I tried to capture just few of the neat little details, such as the authentic "PA State Inspection" sign hanging in the back (below, left), the La Brea Waterproofing Tar, and the Eclipse Oil: "As dark as the night is long." (below, right). Pittsburgh, you continue to surprise me.

Editor's Note: Other Pittsburgh posts you might like: these murals, this summer festival, or this local-history group.

That's So Pittsburgh: Carnegie Museums at the Airport

Waking up more than an hour before my alarm with a sore throat and driving through the rain to the airport to stand in a briskly moving security line for my "personal massage" was palliated by discovering not one but two new (to me) installations at the airport. This one is a collection of "cabinets of curiosities" with either three-dimensional objects or a rotation of images that become clear when you stand in front of them chosen from the collections of the Andy Warhol Museum, Carnegie Science Center, and/or Carnegie Art and Natural History Museums by select famous and not-so-famous people. The mixture of old and new, simple wood and high-tech screens, "names" like Rick Sebak and ordinary Yinzers like a museum security guard is so Pittsburgh.

Editor's Note: You might also like this unusual view of St. Paul's cathedral, a pop-up museum within a museum, or some of the other sights at the Pittsburgh International Airport. You can find Part 2 here.

Friday, November 23, 2018

What Residency Looks Like XXXXVI: Happy Holidays

Sometimes residency looks like spending yet another Thanksgiving in the hospital taking care of patients who aren't having very good holidays either. This shift involved two conscious sedations while Plastic Surgery stitched kids up, one sedation for Ortho to set a broken arm, and one laceration repair under local nerve block that I performed myself. During the day, football games could be heard on a variety of devices, and at night someone put on Christmas songs. My attending bought me Starbucks to drink while I caught up with my notes. When I commiserated with one family on having ended up in the emergency room, she replied that she was just glad we were here to help. These can be happy holidays after all.


Saturday, November 17, 2018

Into the Earth--Literally!

Dear Husband and I recently went on the daytrip of a lifetime. He sometimes accompanies a soprano and/or her studio of adult learners. To make things more interesting than just working through a book of songs, she organizes a theme. The last three years comprised the trio Wind, Water, and Earth, and to properly close out a year devote to Earth, she wanted to give a concert underground…in a cave! So a group of us carpooled halfway across Pennsylvania to Lincoln Caverns, a roadside curiosity since they were discovered when the highway was built about 1930. There was a shallow layer of snow over everything up in the Laurel Highlands We enjoyed brown bag lunches while she described the program for "Into the Earth" to us. At first she thought singing in a cave would be like performing in a dry, echoing cathedral, but in fact when she scouted out the location, she realized it would be more intimate, warm (52 degrees year-round!), and damp. These are limestone caves carved out over millennia by water, which continues to drip. So the cave itself would be a performer, too. She chose healing music, such as a Gregorian chant "Illuminare Domine" that reads, "God, illuminate those / who remain in darkness. / Direct their steps in the way of peace, / Oh God of all humanity." So fitting.


After lunch we wandered the gift shop, which tempted us with magnets, photo frames, agates, polished stones, and various bat memorabilia. The Lincoln Caverns had thousands of bats until the white-nose fungus nearly wiped them out 8 years ago. On our tour we saw only two, sleeping snuggled up to each other. What is remarkable is that the entrance they use to get in and out of the ground is only as large as a quarter! We hiked up the hill and used a ramp and then some stairs down into the second, performance cave. Our guide, Leigh, is an experienced caver and showered us with a wealth of historical and geological facts. One thing I learned is a bad dad joke:

Q. When a stalactite grows into a stalagmite, what do you call’ em?
A. A column.

Another thing I learned is that although the original proprietors had installed steel beams to reinforce the cave for fear of falling rocks, the only thing that has ever fallen in this cave is water. Even neater, at one point we were 95 feet under ground, and there were still teeny little tree roots working their way through the rock. How's that for perseverance?

Some of the minerals make amazing formations like curtains, or slabs of bacon, or pearl buttons, or popcorn. One kind fluoresces under black light (above left) and then holds the light for a second or two after you turn it out. We saw a pool of water that looked very shallow but in fact is more than 2 feet deep—we tossed in pennies to make wishes—and another pool in the deepest part of the walkable cave that looked very deep but what only about 6 inches in depth (below).

We took a very quick tour through the second cave, where DH and E”J”D were waiting for us. He balanced a battery-powered keyboard on his lap for the accompanied pieces. Some of them involved audience participation. And at one point, Leigh turned off the lights so we could experience total darkness. After it was all sung and done, we piled back into the cars to eat delicious Italian dinner at a restaurant in the little town where “J”’s partner had grown up. Then it was home again, home again, jiggety jog.

Friday, November 16, 2018

What Residency Looks Like XXXXV: Dying a Good Death

GoComics appears to have changed their permissions, because I can no longer save a comic to my laptop as an image file in order to be uploaded elsewhere. So go look at this Pearls Before Swine strip about Old Man Johnson coming home from the hospital to die and come back to read the rest of the post. I thought of it after a recent Morbidity & Mortality Conference by my Internal Medicine residency program. Due to M&M rules, I cannot share the case that was discussed, but I can muse about one of the themes that came up.

What is "a good death"? Americans have said time and again that they want to die at home, surrounded by their loved ones. However, most of them will die in an institution such as a nursing facility or a hospital. Usually this is because they are too sick at the end of their lives to be outside medical care. It is hard to tell whether this pneumonia will be the one that finally kills an elderly person, or whether they will walk (or roll) out of the hospital or skilled nursing facility in a week or two. So we treat every pneumonia until it becomes the last one. That's the one that looks like futile care and wasted healthcare resources.

It is even harder not to start the momentum of modern medicine: who would not give CPR to an older gentleman enjoying dinner at a restaurant with his family? But as bioethicist Elizabeth Reis shared, she now realizes she should have stopped those well-meaning strangers from trying to save her father's life. Only the night before he had told his family he didn't want heroic measures, but that is precisely what he got when he suffered cardiac arrest. After five days in the ICU, she realized her father couldn't have the life he wanted, so she belatedly arranged his death. I think we as a society are so unused to seeing what a natural death looks like that sometimes we don't recognize it when it is staring us in the face.

Those are the two extremes: the rare one of dying quietly at home and the more common one of expiring amid the impersonal clutter of ICU machinery. My residency program spends a lot of time talking about how to get comfortable helping patients and family choose either to avoid the machines or that it's okay to turn them off, all in the name of enabling them to realize their dream (and ours) that they die somewhere else. Taking care of patients who die can be emotionally and physically exhausting. If that death happens in the hospital, it is also financially expensive. There are a lot of reasons--individual and social, spiritual and selfish--for wanting deaths like Old Man Johnson's to occur at home.

But I worry that learning how to give patients opportunities, permission even, to say, "No" to invasive interventions such as dialysis, intubation, and feeding tubes biases us against the ones who do want everything done, even if we (and usually they) know they are going to die anyway. The old man who would rather bleed to death on blood thinners than risk a debilitating but not deadly stroke. The middle-aged man who wants to stay in the hospital on dialysis because it keeps him alive enough to see (and say goodbye to) his family, even if he will be discharged through the morgue. The woman who agrees to be admitted every time she is sick, because she knows her husband would not forgive himself if they agreed to the comfort measures that would shorten her life of suffering. It's not a choice if we insist they choose what we think is best.

Image credit Midcoast Images via
Jannie Funster's blog, since I can't
find my copy of Miss Rumphius
(this YouTube version has sound
effects and rhymes!).
This M&M case helped me to identify an area of discomfort in my medical practice, and by naming it, sit with it until it became a little more comfortable. It is not unlike the discomforts that feminism asks us to accommodate, in the name of agreeing that women have the right to make choices different than our own. I do believe there is such a thing as "a good death." I imagine that I want mine to occur in the distant future, quietly. I think of taking my last breath while sitting in a comfy armchair looking out on a garden of lupines on the coast of Maine. Other people have other, equally valid definitions--like Old Man Johnson, his arsenal, and his lighted cigarette.

"I don't think he's going to go quietly." In fact, it looks like he's going to go out with a BANG...at home. And somehow that needs to be okay.


Saturday, November 10, 2018

That's So Pittsburgh: Armistice Day at the Heinz Archive

In honor of the 100th anniversary of the armistice that ended World War I, the local British Heritage group Britsburgh displayed objects housed in the Archive at the Heinz History Center. There were scrapbooks and photographs from a variety of individuals and organizations, including a Captain Paul Howe from Beaver County, and even one from General John J. Pershing himself. I asked the curator how they had come into possession of that one, and she said she would have to get back to me. For his part, Howe had collected snippets from newspapers, his decommissioning papers, wallet-sized photographs, and menus from various officer dinners he attended in France. On the poppy strewn tables, there were also maps, a duty roster, and a little booklet of cartoons used to sell Liberty Bonds by a bank. The glass-enclosed reading room, boxes of documents, and gloves for handling them made me seriously nostalgic for the long quiet hours I have spent tracking down a hunch or curiously pondering over the remains of someone else's life.

After looking at the exhibit, we sat in some rocking chairs and enjoyed part of this mural of Pittsburgh, "The Visible City" (1992-1993) by local artist Douglas Cooper. His memories are in color water paints, while most of the image is rendered in charcoal. The more than 70 panels reaching 4 or 5 stories tall

Editor's Note: You know what else is so Pittsburgh? The Pirates Parrot and the St. Paul summer organ series.