Autumn has come...

and it's about time! The weather has finally turned consistently and pleasantly cool. Despite the dreary and overcast weekend, the sky today was bright blue, and the trees outside below my window offered a palette of reds and yellows.

Tonight my friend Jim comes into town--he'll stay for a night or two. I felt both responsible and hospitable making preparations before he comes:

• Emptying the bathroom trash can. Setting out a fresh towel and washcloth.
• Putting clean sheets on the sofa, along with a couple blankets and a pillow. Turning on the lamp for ambiance.
• Moving the coffee table to the wall for extra space, and putting out an alarm clock. And a coaster.
• Hot water is ready for a cup of hot tea when he arrives, should he desire. Or a small glass of Scotch.

Confessions of an intern in the ICU

As this month in ICU draws to a close, I've had a little time to reflect on my experiences. One of the challenges of ICU care, so I've noticed, is the tendency to objectify my patients. Too often, I know them simply as beings on the ventilator with whom I've never had personal contact. Despite the "intimacy" of medical care--attending to every aspect of my patients' physiology--there is no relational intimacy or physican-patient trust. For these reasons, this month I've sensed a pronounced disconnect between being a medical care provider and being a phsyician. I've done far too much of the former (and not very well), and precious little of the latter. And the strange thing is, I'm the one who misses it!

I wonder how my attendings handle doing this for years and years. Part of me assumes that this is something they never wrestle with. Does it simply take a hardened, thick-skinned person to do well in the ICU?

Inadequacy has also been a feeling I've experienced quite a bit of. Every patient has family members who are deeply concerned...when I'm struggling just to get the work done and merely understand the complexities of critical care, I dread questions from family members. Especially if I haven't seen the patient for a day or two (as a result of the "divide and conquer" mentality to rounding), I feel like a deer in the headlights when I'm asked, "How's my father doing?" "Um, let's see, was he the one on the vent with the renal failiure and the fungemia, or is he the one on the vent with pneumonia and post-op heart valve replacement? Maybe I should check with the nurse and get back to you," is what goes through my head.

And the fact that every patient is really sick, every patient has family who needs supported makes me feel stretched thin, or worse, uncompassionate. And so even though I'm drawn to critical care as a possible subspecialty after anesthesia, these are some of my concerns about entering the field. The eternal optimist in the back of my head reminds me that the more competent I become managing ventilators and the more comfortable I feel balancing 10 medical issues at once, the easier it will be to be to step out of the role of medical provider and be the physician I desire to be.

Ping pong

I had to post this link.

Matrix ping pong

Happy Thanksgiving

Rather than my original plan of sharing the litany of things I'm thankful for this Thanksgiving Day, 2005, I thought I would simply post to say I'm back in the States and hopefully back to blogging more regularly. To my family and friends--you're at the top of that list.

I saw King Tut's underwear

It's Wednesday evening, and I've passed the "tipping point" or our vacation. One of the things a well-intentioned friend had warned me about was to expect some "culture shock." That really hasn't been the case for this vacation, except for some mild annoyance when I have to say "No, thank you, but I really don't care for a burro ride to market" for the fifteenth time.

Another thing I hate: bargaining. I'd sooner come away with no souvenirs than haggle for them. It seems I inevitably feel either that I'm taking advantage of the vendor, or being taken advantage of. Most of the cases of the former are in actuality likely the latter. Yet there's plenty of humor to be found. A typical (and real) conversation follows:

Dad: How much for the instrument?
Egyptian: Twenty pounds. (There are about 5 Egyptian pounds per dollar)
Dad: Let's see, that would be about four dollars. I could give you two dollars.
Egyptian: Deal. In pounds, that's about 15 pounds.
Jonathan, laughing: No, Dad, give him 10.

Other highlights of the trip:

• The Egyptian Museum in Cairo. The "treasures" of the museum include the burial mask, sarcophagi, and Afterlife supplies of the young King Tut. His linen underwear was also on display, hence this post's title.
• A train ride from Cairo to Aswan on a Soviet-era "first class" train. A 10-watt bulb lit my sleeper cabin, a musty smell permeated the room, and the decor seemed to be straight from the 50's. Definitely an experience to remember.
• The pyramids at Giza. At this point I would say something like, "You can't appreciate how big they are until you stand beside them," but I've heard that line so many times that it's past cliche. They are nearly 1/3 the height of the World Trade Center, and supposedly Napoleon calculated that they contain enough stone to build a three-foot wall around the perimeter of France.
• A "felucca" (small boat) ride on the Nile. Amazing gold-to-red sunsets over this great river's western bank.
• Is "EuroTrash" a politically correct term? Just wondering. Anyway, lunch on the cruise ship was a frenzy of French-speaking mayhem. We later dined with two British couples which was much more enjoyable. Another fun fact: If you were to drop the Great Pyramid at Giza onto the Eiffel Tower, the latter would be smashed flat. As would the Louvre.
• Mom has asked a couple of our guides why the different groups in Iraq (Shiite, Sunni) can't get along as well as the Muslims and Coptic Christians who peacefully coinhabit Egypt. Feeling a bit like I was in the middle of a Flannery O'Conner story, I told her the guides probably didn't have a good answer for that.
• Visiting the "High Dam" across the Nile. The first dam was built around 100 years ago (flooding the ancient Temple of Philae which was later painstakingly moved), and the High Dam completed ~30 years ago. These dams forever altered the flow of the Nile, eliminating harmful excessive flooding, but also preventing naturally fertilizing silt from reaching the farmlands of lower Egypt. The lake created behind the High Dam also displaced many Nubians. (I'm sure they all agreed to this project, knowing they'd be well-compensated for exchanging their personal property for a gigantic electricity-generating project.) The High Dam supposedly contains 17 times the amount of material as the Great Pyramid at Giza.

We sail tomorrow for Luxor. Signing off for now...(Imagine a picture of the Sphinx at the top of this entry. It wouldn't upload properly from this internet/smoking lounge's computer.)