Diction

A few months ago I wrote about how difficult it is for me to speak truths to the family of my patients some times, about my realization of the power of words, and my pursuit of speaking clearly.  I am still a work in process in this regards as in so many others.

Today as I prepare for a family meeting, I am thinking about some of the words/phrases that I use on an almost daily basis that are thankfully foreign to most.  Things like "limits of viability," "incompatible with life," "allow natural death"...  These phrases have very specific meanings in my world, but they sound cold, harsh, unfeeling.  Yet sometimes that is reality and there is no sugar coating it.  I wish there was.

20 yrs- Really??

A few weeks ago, I found myself heading to my 20 yr high school reunion with a big sense of trepidation brewing in my belly.  To say high school wasn't exactly my time might be an understatement, but when I'd looked through my photo albums and yearbooks with my BFF on the phone prior to the reunion I remembered that there were some really good times.  Some good friends, many memories and although I have only really kept in touch with only said BFF since high school.  I was curious.  Yet, still when I didn't feel so good that day, I almost gave in figuring I had an excuse. Somehow or another I convinced myself to go.

I arrived at the San Gabriel Country Club and was greated by many familiar faces and many not so familiar. I found some old friends and found easy conversation, interesting people.  Yes, we have all grown up in the last 20 years.  The people who were friendly and interesting, still are!  For the most part, the people who were tools, still are!  Even with that said.  I had a really nice time. I am glad that I went. I was really glad to reconnect with many of the people whom I had known since I was 5 years old, when we all started kindergarten.  I have made plans to see some of them since.

Maybe you can't go back. I am sure that I don't want to go back to high school, yet still it was a really fun evening.

Best wishes SMHS class of '89 it was good to see you again.

Bye Summer '09- you've been good to me.

Today is a rainy SoCal day, it feels like fall has actually arrived here in Los Angeles, and I am ready to embrace a new season. However, this transition of seasons has me looking back over the past season and shaking my head a little because the Summer 2009 might be one for the LK record book.  Really all of 2009 has been pretty good to me. Certainly there were rough times, but as I begin to think about all of the year ending festivities that approach I am awed at what a summer (year) it has been.  

 Summer 2009 dawned with me in a minor state of flux, focussed on training for my triathlon, but worried about things I couldn't control.  I gave up controlling the uncontrollable and just went with things.  The results have pretty much been good.  A few bumps on the way, but forward progress nonetheless.  Then there was the tri...  As July waned, my exercise complusion grew.  I approached the triathlon with excitement and trepidation.  When the day finally came, I was well trained and met almost all of my goals.  Afterwards, I surrounded myself with friends and basked in the glow of completing the race and finishing in the top 1/3 of my age group.  People said I glowed, maybe I did, but I was certainly on a post race high for at least a week.  Then the reality that my Asia trip was fast approaching set in and my focus switched to planning for that.  A few short weeks later I hurtled through time and space,  and I found myself in the admazing adventure that was my trip to Mongolia.   After an amazing week of trying to help the people of Mongolia I set off to relax in Bali.  Bali was unlike any place I have ever been. It was beautiful, it was relaxing, it was centering. And then I came home, and life picked up where I left it.  Again I find myself trying to just go with it, enjoying the journey as it passes.

Whew what a summer it has been, as I think about moving into fall, I fear that this sort of post crazy multi event high might be leading to an emotional crash.  That wouldn't shock me.  What goes up usually comes down, but I feel like my life is on a forward trajectory and my outlook is amazing. Thanks Summer 2009, I'll remember you!

Dear Owner of the dog who attacked Sadie

Thank you so much for your kind note and apology for this weeks incident between our dogs.  It was very kind of you to replace my shirt that your dog ripped even though it was a very old t-shirt.  While it was cute of you to sign it from your pit bull, I truly feel that it is you the irresponsible owner that owed me and Sadie the apology, not your dog.  I have absolutely nothing against pit bulls, some friends of mine have a pit bull who is one of the sweetest dogs ever.  When I am at their house tomorrow, her head while likely be in my lap while I scratch her tummy. However, her owners know she is dog aggressive and have her well trained and don't let her run around the street off leash.  That is the difference

Your dog did what pit bulls were bread to do, attack a dog that crosses their home territory and to desist when the humans get involved.  The fact that I literally yanked Sadie by her leash away from your dog and then hoisted her to my shoulders is why she is unharmed.  The fact that the incident happened at all is because your dog was off leash in public.  That is on you, an irresponsible dog owner.

I take exception to you signing the note from your dog because it really isn't your dog's fault, you just need to realize that you have a dog aggressive dog and not let him run around loose in front of your house.  Bad things can follow...

Thank you very much,

Lisa

This incident occurred during Sadie's and my regular evening walk along our regular path on Monday evening.  I haven't walked back by the house yet, but I know that neighbor and have seen her dog running the streets off leash when he has gotten out before.  We just happened to be in the street in front of their house when he got out this time.  However, aside from us both being upset we are fine.  Sadie is back to normal.  Me not quite, but we're fine.

Wash your hands, please!

In 1845, Dr Semmelweiss in Austria investigated why women were dying of postpartum infections at an alarming rate, ~15%.  He instituted a policy of handwashing after discovering that interns and residents were sometimes proceeding straight from performing autopsies to delivering babies. After instituting the hand washing policy the rate of infection fell to the baseline for the era. Slowly his discovery that hand washing was an important tool to prevent spread of infections gained support.  It is now accepted as gospel truth that dirty hands can spread infection and that hand washing, as simple as it may sound, is one of (if not the) most important weapon against preventing the spread of nosocomial infections.

When I was in Mongolia, I was aghast at the lack of facilities for appropriate hand hygeine.  The staff restrooms often doubled as storage closets.  There was no way to dry your hands.  They did have alcohol gel avialable to use before touching patients, but not at every bedside to be sure.  When the neonatologist there broached the subject of their infection rate, Monica and I immediately launched into a discussion of careful attention to hand hygeine and appropriate patient skin prep and care of central lines.  At first they were resistent, but with gentle support they could appreciate the impact something so simple could have.  Of course, the barriers to hand hygeine in an emerging country are huge.

However, it would be very narcissistic and first world-centric of me to say that the barriers only exist in such circumstances as those I saw in Mongolia, when everyday in my unit we are still working to achieve 100% compliance of all health care practitioners to hand hygeine.  For something so fundamental, I do not think that 100% compliance is an unrealistic goal and fortunately, I have the support of my hospital to try to get there.

Thanks Dr. Semmelweis.  I hope your contributions to medicine will no longer have to be talked about soon.

Book Club

Sunday night in the midst of a severe case of jet lag, I found myself at my friends house for book club surrounded by some of my favorite people.  As always after book club, I am buoyed by the support and fellowship of my friends.

One of the beauties of the group is in our very diversity.  We range in age from the late 30s to 50.  Our careers span the spectrum from producer, special effects production, music management, running a non-profit, real estate to medicine.  Some of our group have children, most do not.  We have burgeoning relationships, dying ones.  We are married, divorced, single.  But all these things are just some of the labels that are so often applied to us as women and used to define our role in the world.  The truth of the matter is for those hours once a month none of those labels are important.  What matters is that we are all friends, and we are all free of judgement of each other.  Oh and yes, we do actually talk about the book in addition to eating fabulous food and drinking wine.

Last month we read "The Little Stranger" by Sarah Waters a subtle tale of haunting set in the dying era of the old manor homes in England.  Next month "The Help" by Katherine Stockett a fantastic book looking at the struggles of race relationships in the South at the beginning of the civil rights movement.

Stillness

“When you learn to quiet your mind, you will hear them too”  (Name that movie and the character who said that and to whom, and you will get, um, nothing, but I’ll know you know too- you can even correct the errors in the quote that I think might be there.)

That quote entered my mind the other day while sitting looking out at a bunch of rice fields in Bali, watching a couple of men chase birds out of the rice that was about ready to be harvested.  

My life generally proceeds at a relatively frenetic pace.  I work long hours, then I try to carve out time to have a social life, to take care of me, to sleep, whatever.  I seem to be always rushing from one place to the next and detesting being late anywhere. A few years ago, I committed to “scheduling” one night off a week.  Literally, when I have weeks that are becoming too full, I’ll make sure that one night stays blocked off for me to not have plans.  I actually calendar my night off. The whole idea of scheduled free time seems hypocritical, but it has made a big difference for me and my state of mental exhaustion.

Yet still, I have been in Bali for 12 days and have rarely found a place so relaxing. I have literally sat and looked at nothing for hours, and I usually don’t sit.  I have actually succeeded in stopping my mind from playing the perpetual what if games.  I can’t ever shut it off, but I’ve turned the volume down at least.  I have found tremendous pleasure in such simple things.  At the beach, I walked along the water every morning and then sat in  a pagoda things and looked out at the ocean and felt the cool breeze blow over me.   I’d think about things important to me, but mostly I’d just be there and look.  When I moved inland, initially I found the same morning ritual in along the edge of rice fields and then when the sun shone again by going for long morning walks (sometimes with people, sometimes alone). I have rarely felt so calm in my adult life.  This new state of calmness prevented me from being able to tolerate shopping in Ubud the other day.  It was too loud, too bustling, too much going on, I had to escape.  (So, if you thought I might bring you home something from Bali- sorry I just couldn’t do it.)  Shopping has always been utilitatrian for me, and I have never been a fan of the whole bargaining game, and well they was nature and sunlight to explore.

Just a few photos from Bali- so many more..

Last night as I started to think about getting ready to begin my 24 hour journey home, some of the trappings of my LA life started to seep back in. I balked.  I know it is inevitable, but it would be nice to live life as we know it with this type of serenity.  An impossibility I fear, but a noble goal.  Let's see how long I can keep that goal in the midst of a 24 hour journey home.