Thinking Thoughts

One of my favorite things about living in Philadelphia is the Rodin Museum, the second largest collection in the world (behind only Paris) of the sculptor’s works. Outside the museum, in front of a beautiful stone gateway, sits a caste of The Thinker, Rodin’s best-known piece that depicts a man hunched over in deep thought.

There is a small but lovely garden between The Thinker and the entrance to the museum, a garden that is truly a wonderful place to sit and think. I’ve often found myself there on quiet afternoons, looking at the trees, peering at the fountain, and letting my thoughts wonder. What could The Thinker be thinking about for all these years? What was so important? Has he got it figured out already? I’ve just spent the last hour reading on hemodynamics and the oxygen carrying capacity of blood – do you think he thought about any of that? Or was there something more important, more pressing?

Eventually, in the garden, I find my eyes drifting towards the main entrance to the museum. It is adorned by Rodin’s largest – and final – project, The Gates of Hell. It is 6 meters high and contains 180 figures; it is meant to depict a scene from Dante; it is terrifying. It is the only sculpture I can imagine that somehow, despite its location in a dark entrance to a museum, can completely captivate the mind of someone who is trying to get some peace and quiet in a lovely garden in the middle of a city. It screams at you. It shrieks. You have to take notice. And sitting there, nearly at the top of it, amidst all the demons and souls, is a miniature The Thinker. And he’s still thinking.

I guess one of the scariest things about death is the eternal loss of consciousness. Of course, on one hand this is silly – you can’t be aware of a loss of consciousness, so how can there be anything to actually fear? Yet in another sense it is nauseatingly horrifying to imagine just how long eternity is. Some have written that hell might not be so bad, given the choice, since at least there is a presumed level of consciousness. And with consciousness comes hope. Of course, Dante thought of all this – his gate of hell carries the inscription “Abandon all hope, ye who enter here."

At the burn center – as in any ICU – we have a lot of patients who are on “life support.” That is to say, they are so sick that we are breathing for them (mechanical ventilation), feeding them (via percutaneous endoscopic gastrostomy tubes) and assisting their heart (with inotropic agents, vassopressors, or aortic balloon pumps). All of them are heavily sedated – they have to be, otherwise they will fight the ventilator and be in agonizing pain. I have no idea what their level of consciousness is. I do know that for some of them there is great hope of recovery, while for others there is practically none.

Just recently, The Thinker was temporarily moved to inside the Philadelphia Museum of Art, while some construction takes place at the Rodin Museum. There now sites just an empty pedicle where the statue usually sits. It’s like he finally figured it out, and quickly got up to do something. And so maybe it’s time to take a break from these eternal questions and just focus on living actions. To just do. It’s worth a try.

Hoya Saxa

Around Christmas time, at St. Mark's, we sing one of those less traditional hymns that I positively love. I say that it is less traditional only because I never sang it growing up, and it doesn't exactly make the list of common carols one hears in shopping malls in December. Amazingly, and wonderfully, we sing the same hymn around Easter. The verses of the hymn track the life of Christ, and the refrain hits on even nature's amazement: "and every stone shall cry."

And every stone shall cry. And every stone shall cry! What a powerful image - that the wonder of God was such that stones wept.

I know many of you know that I recently returned from a trip to Haiti, where I worked at part of a medical clinic. The clinic is connected to a school. Before I went down on the trip, I had watched a DVD which chronicled the history of that school, from its beginnings in the back room of a mud hut to a beautiful structure with over 1,500 bright and happy minds. One of the things that makes those minds happy is food. You can't reasonably expect a child to learn if he or she is literally starving. And so they embarked to start a school feeding program, to ensure at least one meal a day for their students. And in the DVD I was struck by something one of the school workers said. She said that there were children who were literally so thirsty that they would suck on cool rocks they would find in the morning, covered with the slightest bit of morning dew. Children literally trying to suck water from a stone to avoid thirst. If stones are still weeping, it is surely in Haiti.

And yet stones are capable of causing great pain. I am now working at a burn center outside Philadelphia, and we are treating an 11 month old who fell into a pit of burning coals at a camp. His tiny hands wrapped around the coals. A confused, frightened child, falling towards fire, puts his hands out and clenches what he can – the instinctive grasp of a child working against him. Hopefully, he won't need surgery.

The news reminds me that today is the 40th anniversary of the landing of man on the moon. And if ever there was a rock that inspired and filled a generation with wonder and amazement, then surely it is that small rock orbiting our own planet. One upon a time I dreamed of walking on that rock myself, and while my current life and dreams are far from that, it is always something that I cherish in my mind.

And so here I sit, alone in a library, between patients and the OR, thinking of all these rocks and what they have meant to so many different people in so many part of the world. The constant theme seems to be one of action. Stones react, they can give, they hurt, they inspire. There is motion in all this, a motion that we, as bystanders, are privy to if only we look.

And so let us look!

Ready to burn

Just got back from a wonderful long weekend at my parents’ home in Maine. And while there was more than the usual amount of clouds and rain, there was enough sunshine to fully appreciate the awesomeness of the ocean: its expansive power, it’s mystical beauty, its endless bounty. There was a moment, in the boat, cruising home one evening on the sparkling water with the golden trees lining the banks that I thought to myself…this is good. I could do this.

Air travel is a funny thing. The flight from Maine to Philly is just over an hour. My suitcase was waiting for me on the baggage carrousel, and within minutes of touching down I was waiting for my ride. On one side of me a train buzzed by, while on the other buses and taxis lined up. I crossed the busy street, peering down the lane of speeding cars to spy my ride…in such a short time, it seemed, I had come so far.

Just over a year ago I graduated medical school and began internship. Just over a year ago I was new at this game – expectations were fairly low, to be honest, and a watchful eye was never far away. And now I sit on the brink of year two. Expectations are now fairly high, and to be honest I am a bit nervous. I begin at the burn center. In bed one is a nine-year-old boy who has already undergone multiple surgeries. In just one short year, I feel, I have come so far.

And what is there to do but push onward. With the taste of lobsters still fresh in my mind, I’m ready for anything.

Solstice

Today is the summer solstice, the day when sunlight stubbornly sticks around, refusing to leave. Its counterpart, the winter solstice in late December, is historically linked quite strongly to Christianity, as the celebration of the birth of the Son of God – the Light of the world – ushers in a season of increasing sunlight. Christmas literally comes in the darkest days of the year, and its promises of salvation are accompanied by longer days. In some way, I figure, the summer solstice is the culmination of that promise, the day when we are supposed to have realized the full potential of Christmas’s gift

Today is also Fathers’ Day, a day when we remember the love of our fathers, the gifts they have given us, and the sacrifices they have made. I spent today volunteering at my church’s summer camp, helping to prepare meals and do odd jobs. I spoke to my father from the camp – he was proud of me.

I was feeling good and happy when I drove home. But as I was nearing my apartment, a homeless man at an intersection caught my attention. I guess I’ve grown used to the homeless of this city – some of whom I know by name – but I still find that I am often unprepared to look at them. This gentleman was younger – in his late 30s, maybe – and he looked disturbingly numb, like he was ashamed though not yet scared of his situation. He held a sign with messy writing that read “homeless please help a vet.” I didn’t have a dollar on me. I looked at him through the glass, mouthed “I’m sorry,” to which he subtly nodded in acknowledgement, the corners of his mouth trying to make a smile. My eyes caught a small bag of chips I had in my car – I was too embarrassed to give it to him.

And so on this day, the Solstice, the reality is plan. There is good work being done, lots of it, and the rays of the sun make that visible for all to see. But those same rays point to the work, the seemingly endless work, that still needs to be done. And so I give thanks for the opportunities to do that work, and ask for strength and courage to accomplish it.

Happy Fathers’ Day!

Rituals

Every morning, upon awaking, I begin a series of rehearsed activities. I brush my teeth in the same order, wash and dry in what, to me, seems the only logical way to do so, and comb my hair just as I have for, well, for years now (though some wish that weren’t the case!). This, to me, is nothing but my morning routine – familiar, effective, practical.

In the hospital, we have recently spent a good deal of time teaching the new medical students how to present a patient in a formal manner. The concise and orderly manner of stating an update, vital signs, physical exam findings, laboratory date, and finally the assessment and plan. It is effective communication, to be sure, but its strict order assures that nothing is forgotten. Because when things are forgotten, patients suffer. And so somewhere, now, we begin to assign a certain meaning to routine behavior. It helps us better understand what is going on.

The operating room takes this meaningful routine to its medically-logical extreme. Checklists are run, instruments are counted, the steps are articulated…and all the while a patient lays strapped to a table, his viscera exposed, his whole self reduced to flesh and bones. This routine, here, in this place, has bordered on the ritualistic.

Every Sunday in church we witness and partake in many rituals. Words are spoken in precise order, movements are calculated, and there is even some counting….and all the while a sacrifice on a table is taking place. But throughout it all I find myself asking, for whom are we performing these rituals?

If the answer is for God, then that answer is both terrifying and silly. Do we really think God would refuse to hear the prayers of the faithful because they were not accompanied by the perfect sequence of genuflecting? And if God is that particular, than I, for one, am in deep trouble.

Perhaps we do it for ourselves. Perhaps in performing rituals during worship we somehow ascribe a certain level of meaning that we, has humans, need to have. It doesn’t add meaning, in this case, but it helps us better understand all that is going on.

That’s all for now – I’m off to bed, with a new set of routines and rituals to undertake in the morning.

Back for more

I haven’t written for a long time. It’s not because I haven’t had things to say. I think it’s because I’ve had too much to say. But too many thoughts, especially when kept inside one’s head, are not good for anybody. So here’s to more writing. Not necessarily good writing – I’m going for quantity here.

I am nearing the end of my first year of general surgical residency. It’s been a hard year. It’s been a long year. But it’s been a good year. I am so much smarter than when I started. I realize that’s the hope, the goal, the necessity, but let’s be honest, goals aren’t always achieved, and it’s nice to be on the positive end of an investment. So here I sit, ready to end this year and get on with the real stuff of surgery. Let it begin.

But there is one nagging thing that keeps me mind away from the grind. I recently went on a trip to Haiti, to Quanaminthe, where I worked at a medical clinic. As little as I know in the grand scheme of things, I was told I was fully prepared for what I would see. In some ways I was, but in many I was not. Sure, I can read about malaria in a text book and figure out a way to treat it. But I wasn’t prepared for the extensive need I saw. Sure. I had seen poverty, but I had never seen in while attempting to fix one aspect of it that is so tied to finances, to structure, and that relieves on a society to deliver.

So now, at the start of year 2, I am working on two things: how to become the best surgeon I can be, and how to attack health-care delivery in Ouanaminthe. Here we go.

Relativity

I was fortunate enough to attend a wonderful school from 6^th grade through high school.  At the end of my 7^th grade year, my English teacher gave us all a parting present.  She had a stack of bookmarks with pictures of Albert Einstein on them, and each one had a different quotation on it.  She’d sift through the stack, trying to match quotation with student, and gave me one that read this: “I want to know God’s thoughts; the rest are details.”

It’s hard to convince a 7^th grader that there is something more going on than the details of life, but that bookmark went a long way towards making me think about it.  And as I spent the next few years wondering what exactly God’s thoughts are, I found it no coincidence that, inscribed above the physics building of my college was the expression “Nature’s laws are God’s thoughts.”

I’ve learned only a little bit about the theories of Albert Einstein, but I think I get the general idea of relativity – at least, I understand that our concepts of time and space depend on where we are and what we are doing. 

I am currently a month away from graduating medical school, and I have spent the last four years intensely studying nature’s laws as they apply to the human body.  I know God’s thoughts encompass a lot more than the little bit of medicine I have seen this far, but I’ve also appreciated the glimpse into the divine architectural plan that I have been so fortunate to see. 

The further I get away from that late spring day when I was given my Einstein bookmark, the more important his words seem to me.  I find myself asking questions like “what really matters” more frequently than ever.  Moreover, as those questions become more commonplace in my daily life, my memory of being given that bookmark is more vivid than it had been.  If you were to ask me now when I was given that bookmark I wouldn’t know what to say – it feels as though I have been pondering that question my whole life, and yet I find myself doing so with the verve of a scientist on the brink of discovery. 

As it happens, next weekend is my 10^th year high school reunion.  As I get closer to it, the memories are getting thicker and thicker.  On the brink of graduating from medical school and starting a surgery residency, I can't get thoughts of Einstein out of my head.  Getting a glimpse into God's thoughts is one thing, but understanding God's thoughts as they apply to my life - and living accordingly - is something entirely different.  And so it begs the question: am I living accordingly?