I got an email a few weeks ago from our office manager. I'd seen a patient with pinkeye in her left eye, and on the charge sheet, under "diagnosis," I'd written "Conjunctivitis, O.S."
The email reminded me that O.S. -- short for Oculus Sinister, meaning left eye -- was on the official list of forbidden abbreviations. And word's out that next time the JCAHO inspection team shows up to determine whether the hospital remains up to accredidation standards, sniffing out usage of the forbidden abbreviations will be high on their agenda. So I'd better watch it. And that goes for Oculus Dexter,
and Auriculus Sinister and Auriculus Dexter, as well. No Latin. No abbreviations. It's Left Eye and Right Eye from now on. Got it ?
And why ? The abbreviations are "confusing." Confusing ? CONFUSING ?
A beautiful and evocative bit of historical medical terminology is being jettisoned because of, oh, the RAMPANT ILLITERACY OF MEDICAL PROVIDERS ?????
Oh, dear. Had I become some Mel-Gibson-like, ultra-orthodox, Latin-spouting traditionalist freak ?
Qui tollis peccata mundi, anyhow ?
I calmed down.
Medicine has already ruined the whole left/right thing for me, anyhow. I look at people face to face all day. That's Mr Jones' right eye over there, on the same side as his liver and his right atrium, and that's his left eye over there, along with his spleen and his sigmoid colon. So when I think of my own right hand it feels like it's on on the same side as Mr Jones' left hand, so is it my right or left hand ? And when I'm hugging DK and he says "oh, scratch my back" and then "more to the right !" what the HELL does he mean by that ? My right ? His right ? Which is really my left, isn't it ? But it's his BACK, so doesn't that reverse it ?
Where am I ?
Don't even get me started about the brain's diabolically crisscrossed wiring and confrontational visual field testing.
A med school professor claimed that we habitually chose to sit on either the right or the left side of the amphitheater for neurological reasons. I was a right sider. As I am today, at the movies. My right, that is. Facing forward. Toward the professor. Who was looking back at me sitting on the left side of the hall. Or was he ? Would you turn around for a sec, professor ? And raise your right, no, your left hand ?
It's all a sinister plot.
As a corollary, I realized that, whenever I've shared a bed, I've always slept on the left side. Which, as you face the bed from its foot and point at it, is the right side. But when I lie on my back, my left hand dangles over what must be the left side of the bed. QED ? (Can I still write that ?)
And how does bed side relate to auditorium seating ?
So let's see if I've got this straight: I'm left-of-bed, right-of-hall. Assuming the foot of the bed is where the professor is standing. Assuming he is facing us...
I give up.
So the boys from the JCAHO can scour my charts for OS and OD. I'll show them. I can reform, modernize, get with the program. Bring them on, I say.But if the inspector, deeply impressed by my dextrous avoidance of the forbidden abbreviations, were to give me a congratulatory hug and ask me to scratch his back, a little more to the left please, I, and my hospital would be sunk.
Tuesday, December 28, 2004
When our clinic got renovated a few years ago two things happened to the waiting room. It shrunk, and it got a TV, one of those institutional wall-mounted jobs that's perpetually blaring overhead. I don't think it has an off button. Every morning I must pass by Regis and Cathy -- gatekeepers of my workaday hell -- to get to my office. I find myself wincing, quickening my pace, nearly closing my eyes against the stream of cheerful banality. It's not a good way to start the day.
Yesterday morning, as DK had the second of two carpal tunnel surgeries, I found myself in a hospital waiting room. The obligatory TV was doing its full-throated number in the corner. It was, unpleasantly enough, the same hospital in whose ER I'd found myself a year and a half ago, which, at that time, I'd dubbed, acronymously, GICHOTOON -- Grossly Inconvenient Community Hospital On The Outskirts Of Nowehere. Their ER waiting room boasted not one but two TVs, tuned to different channels. So things could be worse. But it was not good. No. Not good.
As I tried to read Thomas Merton on the "Philosophy of Solitude" --
The solitary is one who is called to make one of the most terrible decisions possible to man: the decision to disagree completely with those who imagine that the call to diversion and self-deception is the voice of truth and who can summon the full authority of their own prejudice to prove it.
-- I found my attention, already mildly addled by anxiety, pulled time after time to the loud, bright box .
In an absurdist, even illustrative counterpoint, George Foreman hovered overhead selling his grill, towering amidst a stream of remarkably non-descript, slender, and uniformly smiling young women selling other things. Selling weight loss. Selling food. Selling all species of Human Interest. Selling The Weather. Even selling "Tragedy," their perky smiles briefly dialed down to mawkish looks of concern as they gave 22,000 dead less airtime than our surprise day-after-Christmas storm's eight inches of snow. The smiles seemed to detach themselves, Cheshire-like, from the women. The smiles had minds of their own. They buzzed about like gadflies. I braced Merton open in my lap and plugged my ears.
And soon found myself thinking back to a more harrowing wait of almost 10 years ago. That time I was at a bigger, more imposing urban hospital, Boston's famous Brigham and Women's. Their surgical waiting room was enormous, quiet; its walls were curved and womb-like, and the waiting room was called, in a wierd hybrid of social-work and military speak, "Family Liaison." DK was having bigger, more imposing surgery by a cheerful neuro-otolaryngologist taken to wearing Mickey Mouse neckties. DK had nicknamed him "Dr Maniac." Who, after all, but a maniac could be bold enough to drill into skulls ? A few months prior DK's middle ear had filled with fluid, a common enough affliction, but DK's turned out to be spinal fluid , leaking in through a little congenital hole in his temporal bone. It had taken 42 years for the dura mater to wear through. So this was not-quite-but-almost brain surgery: Dr. Maniac went in through the skull above the ear to do his patch job. (And, it turns out, had to snip off a nubbin of brain "the size of a ballpoint pen clicker" that had herniated through the little hole. DK claims his ability to spell was in that bit of brain.)
And in "Family Liaison" -- perhaps someone had taken a cue from Raymond Carver's "A Small, Good Thing" -- there were muffins. An endless stream of large, warm, fresh muffins, presided over by a kindly, quiet, solicitous man named Tom.
This is the poem I wrote about that wait.
OR Waiting Room
Do you know the muffin man
who lives in Drury Lane ?
-- child’s song
There may be a few angles here
in Family Liaison, but we
are mostly sunk in womby curves
while our loved ones are off elsewhere.
Mercifully, there’s no TV,
but just discrete high end Muzak,
the minor masters of Baroque --
G. Sammartini, Telemann --
and a few Christmas Carols, yes,
but of the not-too-jolly kind,
sprinkled in for seasoning.
Help yourself to muffins, ma’am.
says Tom, our host in Liaison.
The hospital white noise and med-
lies from the sweet Nutcracker Suite
sursurrate so soothingly
I could forget the wedding band
deep in my backpack’s black abyss,
a guest beneath the loosened clasp
of my old change purse, and ignore
bone saws poised above their swift
descent, all whirring too, and in
fact, I slip into a cat
nap dream of spinal fluid, cold
and lucid on the petrous ridge
of temporal bone, bubbling and spry
as water sprung from rock, holy,
numinous, cascading through --
then jolt awake, kinked and adrool
on plump earthtones, between a pair
of Danish Modern arms that, blond,
curve around me, barely touch.
Want a muffin ? queries Tom,
as the 4th Brandenburg comes on,
the dark andante, surely a
tactless as a surgeon’s Oops! ,
two flauti dolci falling side
by side through a vast space where just
three red beacons cast the light --
pointsettia, EXIT, fire alarm --
toward three closed doors marked CONSULT that
are clustered in one inlet. That’s
where they keep it, the bad news.
Take a muffin, insists Tom,
and swipes a red scrap from his lip.
Me, I like the cherry kind.
Below this room the dreary lanes
of Boston’s Mission Hill darken
in the tenth straight day of rain
as sirens sluice down them toward
the sodden hospital, but our
window’s just a snaking slit.
It’s cut below the curved roofline,
onto a view of scaffolding,
and airshaft sheets of concrete, glass.
We ask: has the sun risen yet ?
Will it ?
Eat, he says. Eat.
And here I was, nearly ten years later, in a waiting room again -- another Tom, no muffins, same husband. Eventually a woman with a clipboard arrived. To liaison with me. The surgery was finished. DK was awake. She could bring me to the day surgery recovery room now. I followed her down a yellow, dingy corridor.
There sat DK, goofy from anaesthesia, wolfing down saltines, his right hand swaddled in an impossibly large, club-like dressing. The long room was nearly empty. As I watched my husband eat, an idle nurse reached up and switched on -- you guessed it -- a TV.
"Have a cracker," said DK above the din. He was swaddled in yards of faded hospital gown. Cracker pulp flecked his lower lip. Without his glasses he seemed a stranger.
"No, thanks," I winced.
Where was Tom, any Tom, when I needed him ?
Sunday, December 26, 2004
For two weeks we had a guest in the clinic. A radio. Set to an All-Christmas AM station. It was not enough that the Hospital's Department of Telephony had installed a new on-hold music tape consisting of an extraordinarily chipper version of "The 12 Days Of Christmas" played allegro vivace, the last thing one wants to hear when calling Radiology for the third time for the stat reading that one should have had hours ago -- don't you realize Mrs Jones is totally pissed off and about to hobble out against medical advice on her possibly broken foot to finish her Christmas shopping ?!?! It was even more ill-considered than the on-hold music that had dominated ordinary time: the sturm-und-drangish opening movement of Beethoven's Pathetique Sonata. You thought you were desperate for an Xray reading ? Wait until you've listened to those crashing chords for five minutes. It's enough to propel a deranged walk-in physician (cue The Ride Of The Valkyries) into "The Department" hell bent on exacting a pound of flesh, or at least a preliminary reading of Mrs Smith's stat chest xray.
The urologists -- a practice with a phone menu so unnavigably and fiendishly byzantine that it once actually reduced me to tears -- took their cue from the Hospital and installed a slightly less manic rendition of "The 12 Days" as their seasonal on-hold music. Theirs was customized with a soothing voice-over describing their services. Just imagine the French Hens and Calling Birds and Lords-a-Leaping and Swans-a-Milking with a superimposed narration about incontinence. Then you will understand why I was found screaming into the phone:
Ceci n'est pas un pipe ! Ceci n'est pas un pipe !
The clinic radio, between boisterous commercials, was pumping out mainly the most secular and jolly shopping-and-partying-down bits of the Christmas repertoire. No Coventry Carol or Adeste Fideles or Personent Hodie or Wassail Wassail All Over The Town. Nope. Nary a Good King Wenceslas nor an Undismayed and Well-Rested Merry Gentleman among them. Their playlist seemed to consist of "Jingle Bell Rock," "I Saw Mommy Kissing Santa Claus," "It's The Most Wonderful Time Of The Year," a particularly icky C&W version of "O Holy Night," the Alvin and the Chipmunks' Christmas Album, and, the tune that seemed to recur the most frequently in their jangling rotation -- could it have been every other selection ? -- "Here Comes Santa Claus !"
Which, after the fortieth or fiftieth repetition, caused me to break forth into song:
Here come hummingbirds, here come hummingbirds -- pecking at my eyes !
That's when they hung the decoration on my office door. A large, gaily painted wooden arrow pointing straight at me, which read:
BAH HUM BUG
Friday, December 24, 2004
Saturday, December 18, 2004
I've never seen anything quite like them.
I'd wandered down a path toward the river's edge. It ended at a small cove where the water is slow and shallow and floods when the river is full. A stubble of small twigs rose from the bronze surface just beyond the bank, and on each twig, an inch or so off the surface was a bauble -- a graceful collar -- of glittering ice. They looked like ice bubbles, not spherical though; some were ovoid, some discoid, others conical, all eccentric variations on the torus. The twigs ran through them like axles. The water, from time to time, would swell and touch the bottom of one, but then would recede and leave the bright bubbles suspended there just above the surface. There were dozens of them. They looked like flowers, the ultimate abstraction of flowers, just stem and swelling. They glistened in the low morning sunlight.
How had they come to be, these night-blooming ice flowers ? What vagaries of flow and cold and darkness had nourished them ?
And what species of night-blooming ice flower -- strange, abstract and doomed -- am I, on this darkening way, becoming ?
Friday, December 10, 2004
I came circuitously to Samuel Barber's "Hermit Songs," as if to the end of a long pilgrimage whose goal was both inarticulated and somehow inevitable.
Some years ago my brilliant husband, the jazz composer Darrell Katz, wrote a beautiful song, "Like A Wind." It's a setting of a short passage from Sherwood Anderson's Winesburg, Ohio. He loves that book, and rereads it continuously. I can think of only one other book that he lobbied more tirelessly for: John Barth's The Sot-Weed Factor. Lobbied, I say ? Harangued me to read, is what I mean. Until I grew weary of harangue and picked up his dog-eared, annotated copy and sulked off to do my beloved's bidding.
After multiple attempts spanning several years that all foundered on a tedious and long-winded early expository chapter about Maryland history, I finally finished it. Oh, the sacrifices we make in marriage. The harangues stopped. I will say no more. Although still, today, he shakes his head and gazes at me sadly when I admit that I have yet to read Barth's Chimera. Which inspired another of his brilliant pieces.
Anyway, DK has been mulling a more extended work using more of Winesburg. He was discussing the task of setting an extended prose text to music with a colleague who insisted he must drop everything and listen to Samuel Barber's "Knoxville, Summer of 1915." DK came home wildly enthused, obtained Dawn Upshaw's performance of it, and a few days later told me I must listen to it right away.
I was intrigued. "Knoxville" is the prologue to James Agee's A Death in the Family. "Knoxville" was originally written as a separate, short prose poem and, posthumously I believe, included as the introduction to the novel. I read the novel years ago. So long ago I could remember very little about it. So I dug out my copy, a small, dun, 1960's paperback, the pages yellowing and smelling pleasantly of mold and put it on the things to read pile by my bed.
Then I sat down with the CD liner notes and listened to Barber's setting.
The piece is a child's-eyes view of a summer night spent in the midst of an extended loving family. It moves from homely, cozy close-up of family gathered for small talk on quilts set out on the lawn to the awesome and frightening array of cosmos arched above them ; from the child's comfort in his mother "who is good to me" and his father "who is good to me" to his pained wonderment at the simple, astonishing fact of being there alive on earth on that summer night, and of being loved by beings larger than him who, however, "cannot tell me who I am."
The music is gorgeously lyrical, heartbreakingly sweet, a full expression of the contentments and urgently inquisitive longings of childhood. It's an amazing setting of a beautiful text.
Those of you familiar with my various obsessions and proclivities can imagine how excited I was when I learned Barber wrote a song cycle called "Hermit Songs". I immediately obtained a CD of Leontyne Price's performing them, and have been listening to them this week.
These are ten songs based on "anonymous Irish texts," translated by WH Auden, Chester Kallman, Sean O'Faolin and H. Mumford Jones. They range from the brief and mildly bawdy "Promiscuity"
I do not know with whom Edan will sleep,
but I do know that fair Edan will not sleep alone,"
an acerbic and strange little song with a beautifully sour melody,
through the merry monkish drinking song "The Heavenly Banquet,"
I would like to have the men of heaven in my own house
with vats of good cheer laid out for them.
I would like to have a great lake of beer for the King of Kings...
and the gentle, sweet "The Monk And His Cat,"
Pangur, white Pangur,
How happy we are
Alone together, Scholar and cat.
to the absolutely ravishing "The Crucifixion"
At the cry of the first bird
They began to crucify Thee, O Swan !
which, I must warn you, may make you weep for the grief and simplicity embodied in Price's gorgeous performance,
and the final song: "The Desire for Hermitage,"
Ah ! To be all alone in a little cell
with nobody near me;
beloved that pilgrimage before the last pilgrimage to death.
Singing the passing hours to cloudy heaven;
feeding upon dry bread and water from the cold spring.
There will be an end to evil when I am alone
in a lovely little corner among tombs
far from the houses of the great...
Alone I came into the world
alone I shall go from it.
which rises from a quiet, prayerful beginning into a passionate colloquoy of piano and voice, then falls back into quietness, a graceful arc of music.
Such literary and musical pilgrimages do, thank Heaven and its vats of good cheer, transport us "far from the houses of the great."
Sunday, December 05, 2004
Of course, the Charles River does have its champions -- the intrepid swimmer Christopher Swain, and the olfactory prodigy Roger Frymire, to cite two recent, breathtaking examples.
Then there's Mary T. Early. She apparantly lobbied for the restoring the pretty little footbridge, and got a bronze plastic plaque -- regrettably tacky but well-intentioned -- for her efforts.
Saturday, December 04, 2004
It was the first time I'd walked by the river after dark and I didn't know what to expect. It was a mild, windy, late-autumn night that promised rain, then cold. I'd been walking for an hour and didn't want to go back inside. There seemed to be some fin-de-saison urgency afoot. Something restless, transitional, inevitable. I felt it in the wind and I wanted to be there when it happened.
I crossed the footbridge. The river streamed, more oily and opaque than usual, a few yards below. A few fat drops of rain hit my cheeks. A harsh light burned on a pole on the other side. I turned onto the path and stopped short, in the grip of a mild horror: the horror one feels at the transmogrification of the familiar. Mother, when she becomes a witch. Father, roaring like an ogre.
Through the bare trees, the floodlit back wall of the grocery store glared from the far shore. Only a narrow service road and a chain link fence separated it from the sheer rock wall drop off to the river. The glare backlit the narrow woods on this side of the river, too, and spilled onto the pathside meadow. And on the other side of the footpath, beyond a narrower strip of grass and a row of smallish pines, big industrial garages -- a taxi company, the power company -- incandesced even more brightly.
Under the lights, the meadow was a nauseous, sludgy gray, studded with pale clumps of switchgrass rising from the sod like dead, phosphorescent bones. What had seemed beautiful by day -- the open, airy seedheads swaying in the wind, the gracefully curling, golden leaves -- now seemed like dead, bleached-out, wraith-like beings, victims of some terrible, toxic event.
It was like chancing upon an old friend at a vulnerable, private moment -- sick, grieving, depressed, disheveled -- when they least expect or want to be seen. I wanted to look away but, transfixed by horror, could not.
In the dreadfully misilluminated night, the meagerness and fragility of the meadow was apparant. Peering closely at little weed worlds -- otherworlds -- through my macro lens, I'd missed it. Daylight, so friendly to retina and flora, kept the buildings at bay. At night, under the monstrous kliegs, brick and concrete facades, barbed wire, and armies of scuttling hackneys and bucket trucks ruled.
The beautiful meadow is just a scrap of nature, a remnant, little more than a vacant lot. A sop to the human need for green. Ugliness and industry encroaches relentlessly. The river reeks of oil and waste as it moves over its bed of shopping carts, tires, bicycles, bedsprings. It's a trash ditch, a midden, a clogged gutter. Wierd, stiff froth, dingy white and tinged with brown, gathers in its coves. Good-hearted conservationists have rallied to its banks, but they are no match for the bullying incursions of civilization -- from the shit-filled disposable diaper beside the path, the Pringles box in the buttonbush, the Budweiser cans rusting in the sedges, the squashed Poland Springs bottles in the bayberry hedge, and the Colgate toothpaste box improbably suspended in the bittersweet, to the rusted culverts on the riverbank with their midnight discharges of secret, poison effluents. The bottom line always trumps the riverbottom.
The bully bides his time. He, as usual, has the upper hand. He seems to be savoring the sight of his victim choking, gagging, squirming, retreating. Questioned, he'll claim good-will, claiming, like any abuser, It's for her own good. He'll insist that private industry can and does self-regulate, and maintains fruitful partnerships with conservationists. Why just look at Philip Morris -- oops, he means The Altria Group -- on the cutting edge of nutrition and health education !
From Fallujah to the Arctic Circle to outerspace, he pilots his murderous juggernaut, announcing: We must kill to save ! We must destroy to build up ! More and more dollars surge upwards toward him and his pals, like a cloud of desperate doves, green at the gills. One or two will, might, trickle down, he promises. Someday.
Just look at his face. The little cocksure motherfucker.
So certain he'll keep on winning.