December: Voices, Memories, and Giving

December: Voices, Memories, and Giving

“It’s coming on Christmas.”

The voice may be tenor or soprano. The music may be folk, modern or classical. Whatever your choice, it now begins—Christmas music reemerges as we celebrate the season in sound. We hum, sing along. My husband and I move from Diana Krall and Bill Evans, to the Robert Shaw Choral, Vince Guaraldi’s Charlie Brown Christmas, James Taylor’s Christmas songs. Everywhere, there’s wonderful variety, music becoming the focus of family get-togethers, school celebrations and church events. Music is tradition. Music is memory.

REPETITION AND REMEMBRANCE or “GET UP ON YOUR FEET”

What song do you look forward to singing? Do you play old records or click on Spotify? Some of you might be part of a church choir—but with Covid, you might be forced to abandon practices. But you can always sing to your Christmas tree,  remember the songs that make you joyful for your beliefs.

Music captivated my younger brother in his teens, became his lifelong career and passion, so at Christmas, his Christmas Dreams collection is a favorite. He and my son will grab guitars, play, sing, fill the house with sounds of the season—and they’re always open to requests–grandchildren, cousins, everyone dancing. Be joyful, move your body—that’s all that’s required. Got a new move? Share it, for the holidays are always about health and new life, about blotting out the darkness that pervaded much of the world, about lighting candles, fires, and gathering people together to share food, drink and love. ( But honor your host regarding what you can bring to a celebration and do make sure you are vaccinated.)

DECEMBER: A TIME FOR EVERYONE 

The very existence of the Christmas season will always be connected to new life, the birth of Jesus Christ. It is also about memories, the cranberry bread you make every year. The lights you hang on shrubbery, trees and doorways to light up your surrounding world. The warm room, maybe a fireplace burning and always a hug or words of caring for those who come through your door. Just think: even though Australia and countries on the other side of the equator are unpacking their summer clothes—it’s still “coming on Christmas.”

And yet there are shadows that even a brightly lit world cannot dispel. Maybe this is your first Christmas without a parent, a spouse, your closest friend. This is a Christmas where your time will be spent visiting your son in rehab or remembering to take medication for a recently developed condition. Some of you will travel to rejoice with family and friends, or to mourn with them.  But we humans keep going, healthy, struggling, joyful or sorrowful, we keep on…

MORE VOICES…

Chris Erskine, in his column a few years back, reminded his daughter: “Everybody is someone.” That statement is always true, but during this season when emotions are heightened, memories can hang over one’s day like a dark cloud–instead of mistletoe. It’s best to remember to care for or smile at those you meet. And you could ask yourself, do I really need “another ornament” for the overloaded tree? I know I don’t, remembering that my mailbox has been full of organizations asking for help. Write that check, mail it today. 

So whatever your December brings you, I hope you will experience contentedness, the desire to reach out to others. After all, the season is only beginning, plenty of time to be grateful, to make Santa Claus come alive and for a child. Thanks for reading.

Artwork: thanks to Nancy Haley nancyhaleyfineart.com

This is an older post that has been edited.

THE STORY OF ONE PREGNANT PATIENT & THE APGAR SCORE

 

THE STORY OF ONE PREGNANT PATIENT & THE APGAR SCORE

Virginia Apgar

Writer and physician Atul Gawande, reminds us in his book, BETTER, that much of modern medicine did not just happen—it came to be through trial and error, through the deaths of others, the mistakes and triumphs that IS the history of medicine. In BETTER, a surgeon’s notes on performance, we meet Elizabeth Rourke in the chapter, THE SCORE.

OUR PREGNANT PATIENT

Rourke is forty-one weeks pregnant, having contractions. She’s an internist, on staff at Mass General. Her contractions are 7 minutes part. She reports this to her obstetrician at 8:30 am. She is told not to go to the hospital until her contractions are 5 minutes apart. Standard protocol. (this book was published in 2007). In medical school, Rourke has seen fifty births, delivered 4, and watched one in a hospital parking lot. It was winter, the baby was blue, crying. They covered the infant, raced back into the hospital. With that memory, Rourke finished packing her bag and her husband drives her to the hospital.

SOME HISTORY

Gawande then relates some history of pregnancy and birth that has been recorded. He writes of 21-year-old Princess Charlotte of Wales, in 1817, four days in labor, struggling to deliver a nine-pound boy in a sideways position, his head too large for her pelvis. When he finally emerges, he is stillborn. Charlotte dies six hours later from hemorrhagic shock. Gawande relates that her physician was reviled for not using forceps. In remorse for her death, he shot himself.

Gawande relates other statistical history of births—that in 1933, the New York Academy of Medicine published a shocking study of 2,041 maternal deaths in childbirth in New York City. At least two-thirds of those deaths investigators found to be preventable, that many physicians simply did not know what they were doing. They missed signs, symptoms, incorrectly used forceps and spread infection. Midwives did better.

UPDATE ON OUR PATIENT, ROURKE

Her pain has increased, thinks she must be 7-8 centimeters. She is at 2. Her labor has stalled. Then at 2:43 AM she is at four centimeters. It’s been twenty-two hours. They give Rourke an epidural. This is not a simple procedure. Gawande goes through the steps, explaining the risks, one being the mother’s heart rate dropping and the necessity for a bolus of fluid injections and ephedrine to increase and stabilize hers and the baby’s blood pressure. The baby’s heart rate is being monitored constantly, showing decelerations during contractions and then recovering. When necessary, Rourke (and thus the baby) are given extra oxygen by a nasal prong.

At 6 AM Rourke is a 4 centimeters. At 7:30 Dr. Alessandra Peccei comes on duty. Rourke is 6 centimeters dilated and 100% effaced. Baby is seven centimeters from crowning, head becoming visible at the opening to the vagina. As the hours progress, Dr. Peccei punctures the membrane of Rourke’s amniotic sac. Waters flow, contractions pick up, the baby does not move and the heart rate begins to drop. 120, 100, 80. When the doctor stimulates the baby’s scalp, the heart rate responds.  

SEGWAY to: VIRGINA APGAR, the APGAR SCORE

Virginia Apgar was a doctor working in New York, a doctor who had an idea, one that Gawande states is “ridiculously simple.” It transformed childbirth and the care of newborns. And as Gawande states, she was an unlikely revolutionary for obstetrics, had never delivered a baby, not as a doctor, not even as a mother. But she would often sit down with someone having trouble and say, “Tell Momma all about it.” She was a surgeon, but joined Columbia’s faculty as an anesthesiologist. She became the second woman in the country to be board certified in anesthesiology, helping the practice to have its own division, on equal footing with surgery. Gawande writes that Apgar was appalled by the care many newborns received.

“Babies who were born malformed or too small or just blue and not breathing well were listed as stillborn, placed out of sight, and left to die. They were believed to be too sick to live. Apgar believed otherwise. She had not authority….She was not an obstetrician.  She was a female in a male world. Gawande: “So she took a less direct but ultimately more powerful approach: she devised a score.”

The Apgar score—as it is now universally known, allowed nurses to rate the constitution of babies at birth on a scale from zero to ten. An infant got two points if it was pink all over, two for crying, two for taking good vigorous breaths, two for moving all four limbs, and two if the heart rate was over a hundred. Ten points meant a child born in perfect condition. Four points or less meant a blue, limp baby.  

RESULTS 

Throughout the world, virtually every child born in a hospital came to have an Apgar score at one minute after birth and then again at five minutes after birth. It became clear that a baby with a bad Apgar score at one minute could often be resuscitated, with doctors, nurses providing warmth, physical touch and oxygen, to help the baby gain an excellent score at five minutes.

The results: neo-natal units! The score also affected the management of childbirth. Spinal and epidural anesthesia were found to birth babies with better scores than general anesthesia.

Prenatal ultrasound became a regular process used to detect problems for delivery in advance.

Fetal heart monitors became standard. All these changes, these procedures have produced amazing results. Gawande writes: “In the US today, a full-term baby dies in just one childbirth out of 500, and a mother dies in less than one in 10,000.”

FINAL THOUGHTS    How did Dr. Apgar’s work make doctors BETTER?

The Apgar Score changed everything, being a practical way to calculate and give doctors an immediate feedback as to how effective their care had been.

The Score also changed the choices that doctors made concerning how to do better! They poured over the Apgar results, wanting to encourage results that would make every doctor, nurse, from the most experienced to the novice, a better practitioner.

And our patient, Elizabeth Rourke? She had almost 40 hours of labor and finally a Cesarean section. Katherine Anne was born at seven pounds, fifteen ounces, brown hair, blue-gray eyes, and soft purple welts where her head had been wedged sideway deep inside her mother’s pelvis. Her Apgars: 8 at one minutes, 9 at five minutes—nearly perfect.

MORE TO READ: Find more wonderful information about Health Care in Gawande’s books: BETTER: A Surgeon’s Notes on Performance, COMPLICATIONS: A Surgeon’s Notes on an Imperfect Science, BEING MORTAL: Medicine and What Matters in the End, THE CHECKLIST MANIFESTO: How to Get Things Right 

I’ve read them all.

 

Discussion, Review of Elizabeth Strout and OH WILLIAM!

In her latest novel, OH WILLIAM!–Lucy Barton, the main character and voice in the novel, tells us that when she learns William had been having an affair with her friend, “a tulip stem inside me snapped. It has stayed snapped, it never grew back.” 

 

 

 

 

 

 

Elizabeth Strout hated being a lawyer: “I couldn’t stand up for anybody, even when I believed in their case.” After six months, she left to do the adjunct professor thing in Manhattan, teaching literature—writing. Strout has admitted that there’s nothing romantic about being rejected, but she never gave up. “I often had only two hours every three days to work; I had to make the most of it.”

She succeeded, using her early life in Maine to create Amy and Isabel, Abide with Me and then Olive Kitteridge, her Pulitzer Prize winning collection of stories about a cantankerous wife, mother and former teacher. Example: Olive’s only child, Christopher, has just married Suzanne. Olive leaves the party, goes into the married couple’s bedroom…she crosses the pine floor, gleaming in the sunshine, and lies down on Christopher’s (and Suzanne’s) queen-size bed. …It pleases her to think of the piece of blueberry cake she managed to slip into her big leather handbag—how she can go home soon and eat it in peace, take off this panty girdle, get things back to normal.

…Then later, Olive sees the bride’s favorite pair of loafers. She takes one, smashing it into her purse with the blueberry cake. That’s Olive.

In Olive Again, 2019, Strout deals with Olive’s second marriage, her son’s divorce, her need to move to the Maple Tree Apartments. There she meets characters who have appeared in Strout’s work: Amy and Isabelle, The Burgess Boys. This expansion of the lives of former characters reinforces Strout’s oeuvre and the world she’s created. Toward the end of Olive Again….her mind twirling around, Olive suddenly remembered catching grasshoppers as a child, putting them in a jar with the top on, her father had said, ‘Let them out, Ollie, they’ll die.’

Her next, My Name Is Lucy Barton, allowed Strout to explore new artistic territory by creating Lucy, a writer with a background, a life experience worth exploring, exposing. Strout followed with a collection of stories, Anything Is Possible and now with Oh William! — Strout the writer, Lucy Barton her muse. 

In MY NAME IS LUCY BARTON, Lucy is hospitalized for complications from appendicitis. Away from her children and husband, she awakens to find her mother sitting in the hospital room. There is little positive history to connect these two, but the mother has traveled from Amgash, Illinois, a fictional small town Strout created where people cling to the land, seeking comfort in the narrowness of what they know. The mother’s arrival gives rise to Lucy’s childhood pain: her father locking Lucy in a truck with a snake; the tiny cold house; Lucy staying late at school where she could study, be warm, meet the gentle teacher who believes in Lucy, helps her escape Amgash, attend college where she begins to write about her life, where she meets and falls in love with William!

As she wrote the story collection, ANYTHING IS POSSIBLE, I envision Strout with piles of notes (her process, see previous post) while laboring over themes and visual details to create characters that might have walked the streets of poorer towns, maybe even those in her beloved Maine. In her story SISTER, Lucy has finally returned to Amgash to visit her sister and brother.

Lucy moved close to her sister, she rubbed her knee. “Oh, that’s disgusting. You are not icky, Vicky, you’re–”   “I am so icky, Lucy. Just look at me.” Tears keep coming from Vicky’s eyes. They rolled down over her mouth, with its lipstick.   “You know what?” Lucy said. She stopped rubbing Vicky’s knee and started patting it instead. “Cry away. Honey, just cry your eyes out, it’s okay. My God, do you remember how we were never supposed to cry?”

Strout left a thread in MY NAME IS LUCY BARTON, Lucy’s father, a WWII vet, won’t accept Lucy’s marriage to William, whose heritage is German. Now in OH WILLIAM! Strout explores that thread.

LUCY’S HISTORY…

Lucy married William, they lived in New York City, had two daughters, then later divorced. In Oh, WilliamLucy’s second husband, David, has recently died, her  daughters are grown. William has had women, but finds himself lonely. When he asks Lucy to go on a trip with him, help him search for a half-sister he has newly discovered on an ancestry website, Lucy questions her current role, but then agrees. The book is a trip of remembrance, of adaptation that all couples experience. Memories of their lives, their daughters lives past and present are shared. They talk about Catherine, William’s deceased mother, questioning how this step-sister might exist. The trip revives memories, Catherine putting William in a nursery school. “I’d cry every day at that place…Lucy, I would cry–the kids would circle around me at recess and they’d sing, ‘Crybaby, crybaby.'”
Lucy listens, silently questions how William will react if they actually find this woman, this half-sister.  

With MY NAME IS LUCY BARTON and now OH WILLIAM! Strout has mastered a clipped, direct style, scenes that flow into one another, revealing a character’s thoughts, ordinary, maybe even simple, but always revelatory….he was wearing the khakis that were too short and I had the same reaction I’d had when I first saw him wearing them at the airport the day before, but I was tired from my night and I did not feel it as strongly. 

so often I had the private image of William and me as Hansel and Gretel, two small kids lost in the woods looking for breadcrumbs that could lead us home. …that the only home I ever had was with William…I’m not sure why this is true, but it is. …being with Hansel–even if we were lost in the woods–made me feel safe.              I wrote in the margin, YES! Strout relates a character’s thoughts, questions, pains, and the questioning we all have about our closest relationships. 

I was in rural Maine and what had just come to me was an understanding, I think that is the only way I can put it, of these people in their houses, these houses we passed by. It was an odd thing, but it was real, for a few moments I felt this: that I understood where I was…that I loved the people we did not see who inhabited the few houses and who had their trucks in front of these houses. This is what I almost felt. This is what I felt. 

Again, we check in on our feelings as they flow through us, pinning them down as we question and then say YES.

Every reader comes to a novel with their own past, their own anxieties, beliefs and a view of the world. Getting lost in story can be pleasing, but it can also arouse questions. Reading Elizabeth Strout is a journey. It provides a look at the reality of lives, not always pleasant, not always redeeming. Her characters are flawed, as we all are. But people change and grow. Strout has penetrated those changes in her work. Maybe that is why she again finds her characters gathered on her table of messy notes, waving conjoling, encouraging her to write more about them. I hope she does.  

When Elizabeth Strout Critiqued My Pages

Elizabeth Strout, How She Came to Be A Favorite Author: Part One

An author from Maine, now living and working in New York City, Elizabeth Strout published her debut novel, Amy and Isabelle, in 1998. The basic storyline echoed some unfortunate headlines, examining, “the close relationship between Isabelle and her teenage daughter Amy, how their relationship comes to be strained after Amy is groomed by her much older math teacher.”

A reviewer in the New York Times summarized the new writer’s talent: “…the story’s true drama lies in the palpable, intricate way it examines the ‘scrape of longing’ that drives these characters toward human contact, leaving them raw and bleeding yet also more fully alive.”

I read her debut, then her second novel, Abide with Me, (2006) summarized as: a religious leader, struggling with the death of his wife, in a small New England town, in the 1950s. Still New England, but Strout flexing her writing muscle, wowing some of the reviewers while finding her way. She would go on to win the Pulitzer Prize for Literature on March 25, 2008, for creating the amazing character who appears in a collection of short fiction: OLIVE KITTERIDGE. Now with no place to go but up, Strout published THE BURGESS BOYS in 2013, a novel with Maine roots that takes place in New York City.

I GET TO MEET HER

In the summer of 2006, I did what had become a delightful summer habit, I would attend a writing workshop at the University of Iowa, in Iowa City. The catalogue listed Elizabeth Strout, offering a weekend course on writing THE NOVEL. I signed up.

What kind of a teacher was this future Pulitzer Prize winner that auspicious weekend? Well, nervous, apologizing that this was a new experience for her—but talking about her passion, which of course is writing.

She spent the first day explaining how she’d come to be a fiction writer. I don’t think attendees, myself included, found this very helpful or exciting—but looking back, Elizabeth was truly sharing the nuts and bolts of her writing process, encouraging those of us who might also be experiencing an unusual start, a bumpy start.  

Married to her first husband at the time, Strout mentioned that her in-laws didn’t understand why her dining room and a room in her basement were littered with scarps of paper, quick ideas that she jotted down, pages and pages, most-often written in long-hand and not always placed in organized piles. (Strout later taught herself how to compose at the computer) but I understood that moments of creation often come through the fingers, and at the time, longhand was her process. Though I don’t want to bore you with these details, as a struggling writer, I found it all fascinating.

MY LITTLE GIFT & HER ANALYSIS

Before that weekend, I’d found a furniture advertisement in a women’s magazine, the usual, except that the table had a neat pile of books and Strout’s AMY & ISABEL was prominently displayed. I brought the page with me, clipped it to my homework assignment.

Elizabeth had asked us to provide one chapter from our work-in-progress. I was working on my second novel, THE MOON DOCTOR, (still unpublished) about a burn victim who finds his traumatic experience has given him the power to heal others–without the need for medical school. 

Strout read ten pages from a chapter in the middle of the book. Her final comment:

There’s a lot going on here, and it’s very intriguing. It seems you have quite an interesting plot at work here, and some very good details. I think you might work on making sure every sentence is direct and ‘true.’ We will talk more about this in workshop and conference. (Thanks for enclosing the cover of the brochure displaying my book. That was very thoughtful of you.) Elizabeth Strout.

For interested fellow writers, she underlined phrases, stating that they WEAKENED my presentation. Her message: these sentences were not true to my voice.

Example: All of these thoughts skittered around the encumbrance of his physical body.  YES, I agree, a truly horrible sentence.

He slowly removed the IV catheter from Jolene’s arm. He’d forgotten a 4by4 and instead watched a snake of dark blood pool down onto the bed linen. Strout wrote: good use of detail.

Was Strout a great teacher? No. I know she’d be so much better now, as I have listened to her interviews, she being more assured, eager to share her writing process, because she has succeeded, truly succeeded. And her life has radically changed, her fourth novel, MY NAME IS LUCY BARTON, performed on Broadway, the dialogue spoken by Laura Linney.  

A FEW MORE WORDS ABOUT ELIZABETH STROUT…so next week, I will review Strout’s recent novel, OH, WILLIAM! when Strout is once again in the world of Lucy Barton, the main character of MY NAME IS LUCY BARTON and her collection of short stories, ANYTHING IS POSSIBLE.

Thanks for reading. 

 

What Should We Citizens Know About Our Place in Society?

What Should We Citizens Know About Our Place in Society?

Sometimes there are rewards when one goes into EVERNOTE and finds things. This was a response to a question that came in my email, but McSweeneys never responded. Oh well, dissed again…so I’ll share it with you…

 

 

 

Dear McSweeney’s, Here is my answer to: WHAT SHOULD THE CITIZENS OF THE US KNOW ABOUT YOU AND YOUR PLACE IN SOCIETY? 

It is always better to approach a fearful time with knowledge and understanding. We can downplay fear if every individual focuses on personal worth, yet believes in specific goals going forward.

Partisans who fight against a conqueror display a deep love and belief in the country they fight for. In this time of Coronavirus, our goals must be to save lives, but also to preserve positive elements of our culture.

STAY WELL; PRESERVE OUR CULTURE 

I value what the generations before me and my generation have brought to the foundation and advancement of our country. Turning against a particular group of people in a time of upheaval and fear is always misguided and can get out of control in the hands of overly frightened people. That’s called hysteria, and though we are not there yet, it would be so wrong to see older generations, people of color and newly arrived immigrants as sacrificial lambs. (rereading this maybe we are there now…at least in the minds of some.)

Now is a time for each of us, regardless of age, background and status to view life on a continuum.

GENERATIVITY: WHAT IS IT? DO I LIVE, BELIEVING IN THIS?  

Psychoanalyst Erik Erikson wrote about generativity, stating that in the middle years of adult life we come to realize: I am what survives me.

Though giving birth is the ultimate act of generativity, it is a parent’s follow-through, his and her commitment to nurturing and growing this person, that truly matters. People of all ages experience generativity by creating: a business, song, piece of sculpture, the resolution of a problem, a scientific theory, recipe, article, novel, hybrid-rose.

Generativity means creating the very future itself through teaching, volunteering, voting, forming and helping social institutions—and by currently working to save lives in hospitals, community centers, churches and health centers. In each of these actions resides a part of us and the good in us—because what we generate moves into the future and provides for those coming after.

I am what survives me.

YOUR KEYS TO A HEALTHY LONG LIFE…

Psychologists confirm, that people who want to generate and create, do experience feelings of well-being and low levels of depression. And it is always true that if you are feeling sad or lonely, the best cure is reaching out to help someone else. (In our age of communication, many of us can do this without worrying about exposure to the virus.) And yes, there is some ego or need for power in our acts of creation, but when we generate for future generations, we cover over the power with love.

TAKE THE TEST BELOW

Erikson reminds us that our acts of having children and building societies indicates our “belief in the species.” Even though we know that horrific things can happen on our planet, like this virus, daily we forge ahead believing in our own generative powers and the goodness that can still exist on our earth. Let’s not forget that in these contentious times, if there is to be sacrifice—it should be the giving of time and energy, or of funding hospitals and health centers. This is not a time to distain a generation who has brought our people through other traumas and still have energy, knowledge and hindsight to give to all generations.

P.S. Below is a self-test that each of you can take to see if you believe in generativity. The test if from the Loyola Generativity Scale (LGS).

Read the following six items and mark:

O if the statement never applies to you;

1 if the statement sometimes applies to you;

2 if the statement often applies to you;

3 if the statement always applies to you;

Then add up your score.  Men, women in their 30s, 40s and 50s usually score 11.  Younger adults and adults in their 60s and older usually score slightly lower.

___ I try to pass along knowledge I have gained through my experience.

____I have made and created things that have had an impact on other people.

____I have important skills that I try to teach others.

____If I were unable to have children of my own, I would adopt children.

____I have a responsibility to improve the neighborhood in which I live.

____I feel that my contribution will exist after I die.

Thanks to Dan P. McAdams for the inspiration from his article GENERATIVITY:The New Definition of Success

P.P.SMcSweeney’s is a nonprofit publishing company based in San Francisco. McSweeney’s exists to champion ambitious and inspired new writing, and to challenge conventional expectations about where it’s found, how it looks, and who participates.

Revisiting Thoughts on Liminal Space

After 9-11 life was totally altered, for all of us. As a writer, I sat and stared at my manuscript wondering if anyone would ever read a novel again. My husband had been traveling—not to New York, but to Connecticut. When he finally got home late on Friday, there was relief. But normality escaped us. It escaped everyone.

Then in those next few days, a friend offered me some insight. It came in the words of Father Richard Rohr, a Franciscan priest whose teaching is like that of the first St. Francis: empty yourself, be compassionate of others, especially those that are socially marginalized. Okay. How do I do that when I am angry and confused. 

TWENTY YEARS LATER 

And though time has passed, many of the same questions circle around us. So today, let me offer this…because the words that Father Rohr used to explain liminal space, will always be relevant and helpful when we find ourselves full of questions.

THE DEFINITION 

Liminal Space is:  a unique spiritual position where human beings hate to be… It is when you have left the tried and true, but have not yet been able to replace it with anything else… It is when you are between your old comfort zone and any possible new answer. If you are not trained in how to hold anxiety, how to live with ambiguity, how to entrust and wait, you will run…or do anything to flee this terrible cloud of unknowing. 
- Richard Rohr

HOW WE REACT: COVID 19 and LIMINAL SPACE 

Many of us once again feel this terrible cloud of unknowing. Some of us are angry that our lives have suddenly changed, that we are struggling with loss, death, an alteration in social habits like wearing a mask, avoiding closeness to strangers, having to prove we are vaccinated…the list is long.

Families have been pulled apart, because some refuse to be vaccinated. Why? There are many excuses, some of which I find hard to accept when my generation and the generations of my children began with a series of vaccinations to protect them from illnesses that were not only inconvenient (chicken pox) but could also lead to blindness and deafness in their future children, German measles (rubella), and sterility in males (mumps). So it makes no sense to risk death, damage to one’s lungs, having to be intubated etc etc when many of the refuse-nicks started out their lives being vaccinated. And all they have to do now is WEAR A MASK. 

SO ARE WE AGAIN LIVING IN LIMINAL SPACE?

Let’s look at that definition again. “You have left the tried and true, the familiar, but have not been able to replace it with anything else. Being under a terrible cloud of unknowing.”

SUGGESTIONS…

Having been a healthcare worker, the first thing I would suggest is to work against that vacuum, that feeling of unknowing. Examine questions–can we go out; will we be safe; will my children be safe and still get a good education; can I go back to work instead of working from home? will life ever be normal again? YES TO ALL THESE QUESTIONS. IF YOU ACCEPT THIS NEW REALITY AND GET VACCINATED–and during this interim time, WEAR A MASK.   

THOUGH LIMINAL SPACE IS ONGOING… we must accept it. The feelings that are part of liminal space are common to daily living. We are always waiting for something: a job, a pregnancy, a graduation, a diagnosis, an acceptance letter, even a death; or a yes from someone whose yes might change our lives, and until we get that yes, we feel like someone else is holding the rest of our lives in his or her hands. IT’S NOT EASY. Liminal space brings frustration, depression. We hate living under that cloud of unknowing.

Thus we must look for the good news. It was true post-9-11, that we saw, heard and felt the warmth, love, understanding and giving of many Americans who did whatever they could to help those who had lost someone. Later it was young men and women who joined our volunteer army, feeling that was the best way to give.

Certainly liminal space always challenges us. We are rarely free of the unknowing—because we are mortal and have no knowledge of the date of our demise. That’s a given. But it can be used to power our love of self (taking care of our bodies) and love of those we live and work with (getting vaccinated so that we don’t get sick and infect others.) For how much better to offer understanding, honesty and friendship on a daily basis—because who really knows what the next hour will bring.

You’ll find examples every day of folks who have conquered the awful questioning of liminal space: 

the cancer patient who goes into remission and dedicates her time to helping other patients; the teacher who takes extra time to work with the very student who upsets his classroom; the doctor or nurse who enters the clinic every day, even when Covid death stats are rising; the cop who does all he can to make certain-sure before using deadly force; the mother, father, neighbor, citizen who listens and evaluates any situation before making a judgment or rising to anger.

THE CITIZEN WHO FINALLY REALIZES THAT GETTING VACCINATED IS GOOD FOR HIM/HER BUT IS ALSO A WAY TO GIVE BACK TO THIS GREAT COUNTRY. 

After 9-11 Richard Rohr reminded us that both Christian and Muslim mystics preferred the language of darkness. That is: they were most at home in the realm of not-knowing. In such darkness, Rohr writes, things are more spacious and open to creative response. We are more open to letting in God or blessed, positive thoughts–just like the cancer patient who is grateful for every day and turns darkness into light.

This from the Persian mystic Hafiz:

Don’t surrender your loneliness so quickly.

Let it cut more deep.

Let it ferment and season you

As few human or even divine ingredients can.

Something missing in my heart tonight has made my eyes so soft.

My voice so tender, my need of God, absolutely clear.

In this time of questioning, where we find ourselves often divided, even from friends and loved ones who feel and think differently than we do, try to accept and live in the cloud of unknowing. Try to move a bit closer to the other side or try to find something they share with you. It can be very challenging and just downright hard. But remember, you are both in liminal space, not truly knowing all. And if you have time: watch the film The Hundred-Foot Journey which underlines that people and cultures that are vastly different can cross the threshold and come to a place were there is not only knowing, but sharing and love.

Truly, we have no choice but to live on the threshold, uncertain of which path to take. We exist in this liminal space, a new normal that we must accept and work with so the cloud of unknowing will be transformed into one of understanding.

Thanks always to Father Richard Rohr and the art of Charlie Bowater 

A Woman’s Biology: Risk and Guilt

A Woman’s Biology: Risk and Guilt

Because of their ability to conceive a child, give birth, perpetuate the species, women have for centuries been honored, sometimes considered saintly, but often buried too soon to live a full and creative life. But precisely because of this biological endowment, this ability to help perpetuate the species, women have also been treated cruelly, taken for granted, sometimes considered evil witches with powers that require control and abuse.

As a former Labor and Delivery nurse, I was fascinated by a recent article that appeared in the New York Times. It’s a personal recounting by writer Leslie Jamison of her C-Section experience, and the research she did concerning this medical procedure. (Posting this after the unethical decisions being made in Texas, only underlines the importance of healthcare for women in any situation related to their reproductive rights.)

JAMISON, A PERSONAL HISTORY  

Jamison starts her piece by recalling the words she used to discuss the birth of her daughter. “When they got her out…”

Jamison writes: “…the day after my daughter’s birth, I found myself emphasizing how much I held her, how I never wanted to put her down. It was as if I felt the need to compensate narratively for that first hour, when I wasn’t able to hold her at all—to insist that we bonded just as much anyway. I found myself exaggerating the part about the not caring if I was numb before they cut me open, when in fact I did care. I told the doctors that I would actually love some more anesthesia in my epidural…as if I were trying to make up for other kinds of pain I didn’t experience – unwittingly obeying the cultural script that insisted on suffering and sacrifice as the primary measure of maternal love.”

Jamison states that even now, 3 years later, when women describe pushing out their babies or having 40 hours of labor, she feels a pang of guilt, a kind of shame, as if her own birth story “wasn’t one that merited pride or celebration, but was instead a kind of blemish, a beginning from which my daughter and I must recover.” She then provides a fascinating history of the Caesarian section. A few excerpts: French obstetrician Jean Louis Baudelocque wrote: “That operation is called Caesarean by which any way is opened for the child other than that destined for it bye nature.”

JULIUS CAESAR–AH, THAT’S WHERE WE GET THE NAME? 

There is an apocryphal story that Julius Caesar was born by cesarean, as his mother survived the birth and went on to bear more children—at a time when it was impossible to survive a C-section. She tells us that in 1925 Herbert Spencer, a professor of obstetrics at the University College London, speculates that it “was called Caesarean as being too grand to have been first performed on ordinary mortals.” He also calls it: “the greatest of all operations, in that it affects two lives.”

But Jamison knows and we know, that for most of history, the procedure saved only one life. The mother did not routinely survive, until the 20th century, because before then, the procedure was usually deployed as a last-ditch effort to save the child, the mother dying, bleeding out, or already dead.

MACBETH, A FORETELLING  

Historically and in literature, the C-section was often associated with the imperial, with the divinity. In Shakespeare’s Macbeth, the cesarean-born Macduff experiences a birth that is an answer to a riddle: The witches have promised “that none of women born shall harm Macbeth” but in Shakespeare’s creativity, Macduff is exempt from such a foretelling as he “was from his mother’s womb untimely ripped.”

Jamison, a modern woman looking back on the history of a procedure she has experienced, makes the comment that Macduff’s exceptional birth might grant him some singular power, but such a birth also relates monstrosity. “Untimely ripped doesn’t exactly summon the epidural and the blue tarp.” Jamison knows, she’s been there.

COLONIAL AMERICA 

Of course, the early history of the Caesarean, a little used and experimental procedure, did not insure life for either the infant or the mother. But neither did natural childbirth. The baby was often fortunate if he or she survived. But in the graveyards of Boston and other parts of the New England states, where our early settlers are buried, you can often find a series of graves for a family. First is the grave of the husband, his dates, which always extend his time of life. Then alongside him are his wives—sometimes two or three. No, he wasn’t a bigamist, but when the first wife died in childbirth or from puerperal fever (see below), he married again, and if that wife died, he married again—eventually not for sex or more children, but for someone to raise his progeny, feed and clothe them, tend his garden.

THE SHAME FACTOR 

Jamison also discusses how the advent of the C-section has been used by some to shame mothers. In his book, Childbirth Without Fear, Grantly Dick-Reed inferred that pain during delivery was a lesson women needed to learn. “Children will always mean hard work and will always demand self-control.” Easy for him to say when he’s standing by the delivery table and not lying on it. 

FINAL THOUGHTS  

Jamison’s article is pivotal and for her, she worked through the angst of her fears and regrets. But the end of the article speaks truth for all mothers, no matter how we have brought our children into this world. Jamison writes: Why do we want so much from our birth stories? It’s tempting to understand life in terms of pivotal moments, when it is actually composed of ongoing processes:not the single day of birth but the daily care that follows…diapers and midnight crying, playground tears and homework, tantrums…If we are lucky, birth is just the beginning. The labor isn’t done. It’s has only just begun. 

For more information on Puerperal fever that caused the deaths of post-partum women, go here https://boomerhighway.org/living-in-the-body-part-2/

Bridget Reyes / A Little Muse Photography

Medical Dramas: They Can Educate

Medical Dramas: They Can Educate

I like reading and sharing pieces I find in the NYTimes, Chicago Tribune, WSJ. THIS IS ONE OF THEM… the title of the piece:

IN A TV SCRIPT, I CAN REWRITE A PATIENT’S FATE  by Daniela J. Lamas  

Dr. Lamas is a writer and co-producer for the television medical drama, The Resident, though her main employment is that of a pulmonary and critical care physician at Brigham Women’s Hospital in Boston. 

MEDICAL DRAMAS AND REALITY 

In her piece in the NYT, Dr. Daniela J. Lamas is very aware that she straddles two worlds, finding the writing gig an uplift from the death and dying she sees in her hospital’s Covid unit. When she can retreat to her messy call room, she uses Zoom to join a group of writers struggling with a scene, another medical emergency for Conrad Hawkins (Matt Czurchry), the eponymous hero of the The Resident.

Lamas never works in a vacuum, taking with her the image of the older female patient who now has Covid, her pastor having insisted she not get the vaccine. Dr. Lamas presents this situation to her writing team, hoping they will change the story line. Example: the pastor visits, sees his parishioner suffering and begins to preach from the pulpit that all his people need to get vaccinated. (But like Dr. Lamas, this story line is my creation. Will the writers group accept it?)

Dr. Lamas writes her reality: …though her lungs are slowly improving, her kidneys are worsening, and she is profoundly delirious, not waking up. We stand at the bedside and call her name, her eyelids flutter.

Down the hall, we titrate drips and manage vent settings for a man whose stem cell transplant cured his leukemia but ravaged the rest of his organs. His wife would be at his bedside, but she is at her father’s funeral.

And though the article does not say, I imagine this elderly woman did die from Covid, an unnecessary death.

STORY LINES THE WRITER’S ROOM REJECTS

Dr. Lamas writes: I used to want to show the hospital as it truly exists, to reveal the humor and tragedy and grace that characterizes my world. (She explains with the following examples.)

  • The family that came to say goodbye to a dying woman, a misplaced ID card leading them to believe, wrongly, that she was their mother.
  • A patient’s brother, with skull tattoos on his shaved head, who told us he could not be in the room when we took his brother off the ventilator. So when he left, we thought we would never see him again, but were surprised when he returned, not to sit by his dead brother, but to collect the man’s prosthetic leg. Another nurse said he spent the rest of the day in the hospital chapel with the leg beside him.

Dr. Lamas writes that even producers and writers for The Resident say such stories are simply too grim. The public does not need or want to be reminded of how quickly things can go bad, how families fall apart, how doctors do their best but patients still die.

Especially now, viewers want to see their doctor as heroes, to follow a formula that has doctors saving lives more than losing them.

IN THE WORLD OF THE TV HOSPITAL

Dr. Lamas writes: “During my first experience on the set…I learned that when things went wrong (a medical word being mispronounced) I was assured, “Don’t worry. We can fix it in post.” She underlines that she loved that phrase, one she wanted to say to her patients over and over. “…to be able to have another chance, to treat the sepsis earlier, to stop the pastor form advising against vaccination, to fix it in the post.”

Dr. Lamas reminds us that during the pandemic, her roles as a critical care doctor and a television writer are often in conflict. Though she wants to honor and remember every patient who died, she also yearns to tell stories that are hopeful, where there is always the chance for recovery, no matter how dire the diagnosis.

“It’s a tension I am still learning to navigate. How do we tell stories that feel true while also keeping viewers engaged? What kind of cheats are acceptable, and which are irresponsible?”

Dr. Lamas then makes a particular reference to the struggle that often ensues when the team is trying to save a cardiac patient. She reminds us that TV characters survive cardiac arrests far more often than people in real life do.

“…and the nurse left alone to clean up after the death…” If our viewers could see that, “they would change the channel.” She is right. I still remember during my Cardiac rotation, watching a team try to save a patient, the family waiting in an adjoining room. The man died. And yes, the floor was littered with medical pads, bottles, wipes, tubing…

IN THE REAL WORLD

Dr. Lamas is right when she stresses that medical dramas are important, that they can provide escape, but also education.

“In the writer’s room, we have a change to …offer a different ending to the story. And in doing so, we can sneak in potentially lifesaving education—early warning signs of certain illnesses, the dangers of overtreatment or the impact of inequities in access to care…television dramas have an unparalleled opportunity to educate and even to change behavior…I have come to believe that it is worth glossing over the facts IF we can weave a story that encourages viewers to trust science, to get vaccinated, to look differently at disease. When I find myself fact-checking what I see on the television monitors, I remind myself of this more important goal.”

Dr. Lamas ends her piece, mentioning a patient that she met one morning on rounds, asking him to mute the TV show he was watching, a medical TV show, as she needed to listen to his heart. He seemed surprised that he had to miss something, explained that medical dramas had been his one constant. The plots reassured him, taught him what might be ahead in his own medical story, while helping him feel less alone on his own medical journey. Dr. Lamas smiled. She understood.

(I confess that one of the reasons I became a nurse after having my three children—was my propensity to be gripped not only by books and articles about medicine, but by watching television medical dramas. I’ve written about that before. I was an avid ER fan. Now it’s New Amsterdam, Chicago Med, and of course The Resident.)

A Short Critique of Modern Love, Season Two…

Modern Love, short films based on stories sent to the New York Times, is back. Season Two. Minnie Driver kicks it of off with a charming story of a woman and the sleek sports car she loves to drive, though it requires many repairs to keep it alive. But slowly we discover the car is really something more, a symbol of the love this woman had for her first husband who has died. Watching her interactions with her daughter and second husband, we realize there is more to that aging auto than snatches of her memory. There is love and something else: a spiritual connection? Or something magical as Minnie drives the curving steep roads of the Irish countryside, always returning home safely.  

An Irish background is repeated in another story, where we meet two people traveling on a train from Galway to Dublin. Gradually they speak to one another, then sit with one another, hoping to have a real conversation when they are on the train, heading back to their respective careers after holiday. But why wouldn’t a tale of modern love include an exchange of at least an email address? But it’s a story and the very word story means a surprise is included. 

REVIEWS OF MODERN LOVE, SEASON TWO 

Critic Roxana Hadadi writes: “Modern Love was affected by COVID-era restrictions, with episodes that filmed in New York state and Dublin, Ireland. But the lack of technical creativity is a noticeable distraction. The green screen is eye-searingly conspicuous, imagined sequences are slightly embarrassing, and an over-reliance on flashbacks signals an awareness that the dialogue isn’t doing quite enough work to communicate the details or dynamics of these relationships in the present. “Modern Love” is easy to watch because it’s so non-challenging and because it asks so little of its viewers. But it’s even easier to forget.”  

But we will continue to watch, finding the story lines interesting, and the actors more than capable of awakening the plots. It’s always a combination: writer and actor. If the story doesn’t touch you, all the hard work from the actors might not touch you either.

LOOKING BACK TO SEASON ONE:  

The consensus on Rotten Tomatoes: Carried by its charming cast, Modern Love sweet and simple sensibilities are easy enough to enjoy, even if its quaint portrait of modern life in New York City doesn’t always ring true.

My favorites from Season One:    

  1. A single book critic bonds with her doorman following an unexpected pregnancy. 
  2. When a journalist asks a dating app’s CEO if he’s ever been in love, it sparks a conversation that will change the course of both of their lives.
  3. A gay couple hope to adopt a child.
FINAL THOUGHTS:  If you like short stories that shout out a New York City milieu, Modern Love Stories are for you. 

A HOUSE FULL OF WINDSORS

A HOUSE FULL OF WINDSORSSometimes you come across a novel that reminds you of your own personal proclivity (and to better explain: a tendency to choose or do something regularly; an inclination or predisposition toward a particular thing.)

Those who regularly read my posts, know that I am quirky in some ways, one of them being that I have an interest (a slight passion?) about all THINGS BRITISH. But especially the Royal Family, the Windsors.

And most of you know that this started because of my name, which led me to read British history as if I were preparing for a Master’s Thesis, all while being encouraged by close family members who visited England and brought me memorabilia; all while discovering it was meaningful to cut articles about the Windsors out of newspaper, or save magazines with photographs, ask for books about their lives and watch royal weddings on TV.

My family didn’t mind too much, because if they questioned me on this rather strange proclivity, I could always say it’s just another way of learning more about HISTORY. 

But then, along came…

A FELLOW ANGLOPHILE  

Because the Internet connects you to people you would otherwise never meet, and thus connected me to Kristin Contino, who when it comes to this particular proclivity, this love of the family of Windsor, certainly has me beat.

Kristin’s many trips to England have been recorded with numerous photos. And when a major royal event was about to take place, she and her family once again made the trip, finding a spot near Windsor Castle and able to be up close and personal observing the pageantry of the marriage of Prince Harry and Meghan Markle. After that, I knew I’d found an even more ardent follower of the Windsors…but that event was only the beginning….

Kristin has a reproduction of a bright red British Phone Booth in her home, not to mention those items which all of us seek out when celebrating the royals: tea towels for weddings; tea cups and plates; photos and books. I have a few. (See some of mine below.) Kristin? She’s the QUEEN OF COLLECTIONS. 

And then the final example of her passion, the arrival of Contino’s novel: A HOUSE FULL OF WINDSOR, a delightful story whose main character, Debbie Windsor, falls in love with a member of the landed gentry, Alan Percy—and whether it’s being enthrall to London or Buckingham Palace or her love for Princess Diana and everything royal, Debbie collapses into the arms of this tinged with royalty but not so gentle man—and bloody hell, she gets pregnant. First with Sarah and soon after, with twins!

But later, we find her back in the good old US of A, her marriage over, yet her desire still for all things royal filling up her house. Debbie has become a hoarder. She lives in a house full of windsor. And because she now has trouble navigating her rooms because of the overflowing bins of British mementoes, her three children know that SOMETHING MUST BE DONE.

Will Debbie find a pathway through her living room? Will Sarah, who provides the reader throughout the novel with her Sarah Says tips, have the answer? Maybe so, as her first TIP encourages readers to be ready for company, but then immediately acknowledges that in her family, “dirty secrets are best swept under the rug.”

I’m sure Kristin Contino had fun writing this book. Her photos of her trips to England, her love of those red telephone booths are testament to that. The novel is light-hearted and from page one presages a happy ending. Her characters make predictable decisions so that everyone is jolly and red-cheeked with happiness in the end. And the novel is clever, the hoarding is real, because when you’ve fallen in love with the photos of the Windsors and Princess Diana, it’s understandable that you might go for cheeky Alan, that rotter, who chases birds (that’s British slang for girls)—but in the end decides that bloody hell, you better let your children help you out so that life is cracking again.

A HOUSE FULL OF WINDSORS