My father is a brain surgeon, which also makes him a natural-born skeptic, a person with a god-like penchant for saving lives, and a touch of Hubris. His dedication to science and his own knowledge and abilities makes him exactly the kind of person you’d want drilling into your skull as I watched him do recently on an extended take-your daughter-to-work-although-she’s-grown-and-already-well-on-her way-into-her-own-career weekend of sorts.
The experience confirmed what it is I already know about him: he is a brilliant surgeon, life and death literally hangs on his ability to hold steadily onto a knife and make immediate, precise calculations, without time for pause or reflection. What I did not know is that he does not always win. His best cannot always heal his patients and yet he gives his best to them, day after day.
The weekend began as I watched him remove a large blood clot from the temporal lobe of a sixty-some-odd-year-old patient. I’ll call him Richard, for the sake of this piece. His tools were as age-old as a carpenter’s-- a drill and hack saw, which he used to remove a piece of skull and plunk it into a metal tray for “safe keeping” until the end of the surgery when he would summarily screw it back into place with tiny metal hinges. He also wielded a suction instrument in concert with an extraordinarily complex computer generated model of the Richard’s brain that helped guide him during surgery, so that he did not damage any critical parts that would incidentally shut off heart or lung function. He said to me excitedly during the surgery, “Look there’s Wernicke's area. If I nick that Richard wouldn’t be able to talk when he wakes.”
Of course, my father didn’t nick Wernicke's area or any other critical parts of Richard’s brain. He did as he set out to, successfully remove a pulsing clot the size of a golf ball. Richard woke up; squeezed my father’s hand upon instruction and then that of his grateful wife. After some time and rehabilitation, he would resume his normal daily life activities.
That night, after the grueling eight or so hours on our feet, we went to dinner, we danced, we toasted. This, of course, is what we mere mortals want to understand about medicine and surgery. We go to the doctor because we want to be healed.
What I did not know, what I came to discover in the course of that weekend is that my father does not save everyone he meets. In fact, Richard was the only patient my father would save during the course of that weekend. The other two would die, not because of what he couldn’t do for them, but because even if he did operate, in the end it would not save them.
One was an elderly lady (we’ll call her Faith) he had operated on a few days before, but her recovery was not going well. Although he could have operated again, she had signed a DNR before the surgery and he was reluctant to prolong her life against her wishes, even if she was the matriarch of a family of twelve. The other (Pete for the sake of this essay) was a forty-five-year-old with a nine-year-old son who came into the ER with chest pain and his scans revealed both lung cancer and four metastatic tumors that had broken off and found refuge in his brain.
As he looked at each chart, explaining to me the intricacies of each case, the cause and effect channeled through science, it became unbearably clear: these people would not make it. Despite his extensive training at the best medical schools, his years of experience, his best science, he could not save them.
This is exactly what we don’t want to hear from our doctors, what we don’t want to know is that medicine is still a roll of the dice. What you have determines if they can save you and we are still creatures bound to a matter of when not if. As a kid, I knew this in a distant kind of way, but I’d never actually seen him lose a patient or tell a family that there was nothing medicine could do. I also thought it was a rarity, an unlucky few that were lost.
As the weight of this played out through the weekend and the score card shifted in the favor of loss, I began to wonder how it is my dad got out of bed each morning, how he even kept trying at all.
It was when we met with each of these patient’s families to tell them that their loved one would be lost, that I came to understand my father as truly an eternal optimist.
Remarkably, during the course of each conversation, he did not look down and away as I expected he might. He did not bemoan what his hands could not do for them. He did not send these families away in tears, either. Instead, he asked each family member what their loved ones liked to do the best. This got the family members talking, not about the death imminently before them, but instead about life.
Faith’s family started talking about how she liked to make pirogues and weren’t they all lucky that she’s been doing that in her own kitchen up until last Saturday afternoon. My father used this fact to help them understand that even if he took her to surgery again, she would not ever be able to make her pirogues and did they really want her to live like that?
Pete said that he liked to play golf. My father told him, he should go with his son to do that. Even if he felt dizzy? My father assured them it would be okay as long as he didn’t drive there himself. He also told Pete that he hoped when his time came that he would be out on the course.
When we left each room, I expected my father to look down, to be sad, to walk with the weight of the world on his shoulders, laden with a heavy heart. Instead, he walked upright, moving quickly and eagerly toward the nurse’s station where a stack of charts, his next patients, waited. After all, there were some he could save. And for the rest? It was the time they spent here he reminded them to cherish.
Sunday, February 21, 2010
Friday, February 19, 2010
Death and Taxes
There isn’t a single one of us who won’t pause this year while doing our taxes in light of yesterday’s tragic attack on the Echelon 1 building in Austen, TX. Death and taxes, the two things we joke about being the only inevitability in life, slammed together in this desperate, horrid act perpetrated by yet another homegrown terrorist.
I can’t presume to understand what was going through Andrew Joseph Stack III’s mind when he burned down his house, got in his car, drove to the airport, got in his plane, flew low over the bustling city of Austen on an eerily beautiful, clear day, and then crashed into the giant windowed face of the Echelon 1 office building. Thankfully (if that’s even the phrase), there were limited casualties. Yet, even one life lost to violence (even in this day and age) is one life to many.
In the days and weeks that follow, we will come to learn Stack’s twisted reasoning. We’ll come to feel a deeper sorrow for the families touched by this tragedy, including Stack’s own. Many of us will probably ask: Are taxes really a matter of life and death?
It is easy (or not so easy) to forget that taxes have caused a great deal of violence around the world, especially in this country. (Second only to religion.) Five souls were lost at the Boston Massacre, 168 in the Oklahoma City bombing, 2 now in Austen, TX. (It should be noted here that no one died at the Boston Tea Party.)
We fought a revolution over taxation and the recent Tea Party Activists have been eager to remind us all of the heavy toll we pay at the end of the day to an ever-expanding government. To which others of us have responded: How high a price is too high a price to live in the greatest nation?
As a sound bite –Man Angry At IRS Crashes Plane Into Building – many could probably sympathize. (This is of course before reading two lines into the story to find out that lives were lost and people were hurt, which removes all sense of levity.)
While most of us hate doing our taxes; today, I am struck not by what our tax code says about death, violence, and revolution – this is, as far as I can tell, absent from the instruction book-- but instead by what its rulings are on a litany of life-altering choices. The 1040, in a certain light, serves as a "how to" live guide of sorts for those who want to enjoy the highest standard of living (keep the most of what they earn in their own pockets).
I can’t presume to understand what was going through Andrew Joseph Stack III’s mind when he burned down his house, got in his car, drove to the airport, got in his plane, flew low over the bustling city of Austen on an eerily beautiful, clear day, and then crashed into the giant windowed face of the Echelon 1 office building. Thankfully (if that’s even the phrase), there were limited casualties. Yet, even one life lost to violence (even in this day and age) is one life to many.
In the days and weeks that follow, we will come to learn Stack’s twisted reasoning. We’ll come to feel a deeper sorrow for the families touched by this tragedy, including Stack’s own. Many of us will probably ask: Are taxes really a matter of life and death?
It is easy (or not so easy) to forget that taxes have caused a great deal of violence around the world, especially in this country. (Second only to religion.) Five souls were lost at the Boston Massacre, 168 in the Oklahoma City bombing, 2 now in Austen, TX. (It should be noted here that no one died at the Boston Tea Party.)
We fought a revolution over taxation and the recent Tea Party Activists have been eager to remind us all of the heavy toll we pay at the end of the day to an ever-expanding government. To which others of us have responded: How high a price is too high a price to live in the greatest nation?
As a sound bite –Man Angry At IRS Crashes Plane Into Building – many could probably sympathize. (This is of course before reading two lines into the story to find out that lives were lost and people were hurt, which removes all sense of levity.)
While most of us hate doing our taxes; today, I am struck not by what our tax code says about death, violence, and revolution – this is, as far as I can tell, absent from the instruction book-- but instead by what its rulings are on a litany of life-altering choices. The 1040, in a certain light, serves as a "how to" live guide of sorts for those who want to enjoy the highest standard of living (keep the most of what they earn in their own pockets).
Some of these many of us are doing anyway:
- Get Married. While historically taxes were structured in such a way to penalize high earning married couples both in the workforce, this year you save an average of $3 on your joint return.
- Have children. Procreation is rewarded on line 42 (the higher the number the more the exemptions); 51 and 65 (depending on income brackets.) Put another way: for any one of this generation hoping to cash in on social security, you best pray we are multiplying like rabbits.
Some are slightly more controversial:
- Buy a house on credit. Schedule A, line 10: The higher the interest the better. By the way, did this have anything to do with the housing meltdown we are clawing our way out of with line 67, the first-time home buyer credit?
- Buy a new, preferably expensive car. Schedule A, line 8: This year it is perhaps an investment you’ll want to make in the company we all own as American taxpayers.
Some are just sound advice:
- Get an education. Benefits abound here, see lines 33,34,49.
- Save for retirement. Lines 32 and 50 because, let’s face it, many of us are not procreating like rabbits, despite the potential advantages already sited.
- Give to charity. Schedule A, line 19: Even if you can’t keep it, there is pride in choosing your own worthy causes.
And some, while perhaps well intentioned, seem to fall far short of any intended benefit to society:
- Outsource the care of your children or aging parent. Line 48, you only get a benefit if you hire someone else to raise your child, not if you sacrifice your own earning potential to do so,
If this all seems too complicated, you can hire a professional and get the expense back next year (Schedule A, line 22.) Yet, someone’s making money on your money for the year.
In reality, how many of us are going through the tax code to make up our minds to walk down the aisle, have a baby, take in an aging parent? It’s scary to think that with the right accountant, one could.
Perhaps more pointedly, with a list as complicated as this one, how many things have to go just right to pay the minimum tax burden? Probably just about as many things that went just right for Stack to steal the life of only one person.
National sales tax, anyone?
Thursday, February 18, 2010
To Olympic Dreams That Never Die
It’s that time again, the Winter Olympics. Twice a decade, we set aside our differences and gather as nations, watching in awe as the best of us stretch the boundaries of speed, grace, the human spirit and imagination.
As a kid, I loved watching the Winter Olympics. In the spirit of the games, my brother and sisters and I would vie for the most comfortable seats on the living room couch, elbowing each other in a rush for the center of the sectional to stretch our feet up on the ottoman with a front and center view of the TV.
For the next three hours, we would sit riveted as mere mortals, teenagers not much older than ourselves, blasted down snowy mountain sides or ice glazed tracks at speeds we couldn’t imagine our father getting down the highway in his suburban. We would shout and cheer when the US goalie made a game winning save and suck in our breath as a couple’s skater failed to land a triple lutz. It is among the few evenings I remember being allowed to stay up until the eleven o’clock news and only then would my father shoo us off to bed.
At night, I dreamed about the skills I would need to acquire and I’d do the requisite math to imagine how old I’d be when the next Olympics would come around and I could make a go for the gold. Like an actress planning her acceptance speech at the Oscars, I would stand in front of my closet mirror with my skis held up on my shoulder or a set of ice stakes hanging loosely around my neck and play out my interview with Bob Costas.
In the morning, my sister and I would practice for whatever sport we’d seen the night before. We’d point our selves straight down all 250 vertical feet of our local ski area Lost Valley or we’d lie flat in our sleds down Bran’s hill. She broke her arm not once, but twice, at what passed for our hometown skating rink, a flooded soccer field at the end of the block. I think we were practicing a lift of some kind and became hopelessly tangled in one another.
Despite our failed attempts, I never stopped believing we’d make it to the Olympics.
We are grown now, but this Olympics has not really been all that different, except of course we are in separate living rooms scattered across the US with our own children curled in our laps or on our couches.
The spectacle is as spectacular, if not more so and the US is winning a hefty collection of medals. Yet, as I watch the stats for each athlete come up on the screen -- name, country, height, weight, age -- it shocks me to realize that I am older now than most of the athletes I am watching.
Call it force of habit, but I spend the next couple of hours wondering still if I can train myself to do what I see on the screen. I watch a bump run, and think sure, I’ve got good knees. But when the medal stand fills up with skiers who can do a back layout, I immediately shift my sites to the next sport. Then, an ice skater lands a quad and I remember that I never really made it that high off the ice. I can feel it suddenly, my chances of gold growing slim.
Yet, when it’s late, and after I’ve settled our daughter into sleep, as I am brushing my teeth, I can’t help but smile in the mirror, stand back and imagine Costas sitting across his desk, asking me how as wife, professional, and mother I could fit it in to train.
It is a hard thing to realize or admit that certain dreams in life won’t come to fruition. It is also no fun to do so.
So, I squat down stubbornly and make a pose like a downhiller. Even though my knees crack when I stand up, I’ll still pretend that all it will take is a little practice. Or maybe, I’ll try cross-country skiing. That’s something I can train for with our daughter in a backpack.
As a kid, I loved watching the Winter Olympics. In the spirit of the games, my brother and sisters and I would vie for the most comfortable seats on the living room couch, elbowing each other in a rush for the center of the sectional to stretch our feet up on the ottoman with a front and center view of the TV.
For the next three hours, we would sit riveted as mere mortals, teenagers not much older than ourselves, blasted down snowy mountain sides or ice glazed tracks at speeds we couldn’t imagine our father getting down the highway in his suburban. We would shout and cheer when the US goalie made a game winning save and suck in our breath as a couple’s skater failed to land a triple lutz. It is among the few evenings I remember being allowed to stay up until the eleven o’clock news and only then would my father shoo us off to bed.
At night, I dreamed about the skills I would need to acquire and I’d do the requisite math to imagine how old I’d be when the next Olympics would come around and I could make a go for the gold. Like an actress planning her acceptance speech at the Oscars, I would stand in front of my closet mirror with my skis held up on my shoulder or a set of ice stakes hanging loosely around my neck and play out my interview with Bob Costas.
In the morning, my sister and I would practice for whatever sport we’d seen the night before. We’d point our selves straight down all 250 vertical feet of our local ski area Lost Valley or we’d lie flat in our sleds down Bran’s hill. She broke her arm not once, but twice, at what passed for our hometown skating rink, a flooded soccer field at the end of the block. I think we were practicing a lift of some kind and became hopelessly tangled in one another.
Despite our failed attempts, I never stopped believing we’d make it to the Olympics.
We are grown now, but this Olympics has not really been all that different, except of course we are in separate living rooms scattered across the US with our own children curled in our laps or on our couches.
The spectacle is as spectacular, if not more so and the US is winning a hefty collection of medals. Yet, as I watch the stats for each athlete come up on the screen -- name, country, height, weight, age -- it shocks me to realize that I am older now than most of the athletes I am watching.
Call it force of habit, but I spend the next couple of hours wondering still if I can train myself to do what I see on the screen. I watch a bump run, and think sure, I’ve got good knees. But when the medal stand fills up with skiers who can do a back layout, I immediately shift my sites to the next sport. Then, an ice skater lands a quad and I remember that I never really made it that high off the ice. I can feel it suddenly, my chances of gold growing slim.
Yet, when it’s late, and after I’ve settled our daughter into sleep, as I am brushing my teeth, I can’t help but smile in the mirror, stand back and imagine Costas sitting across his desk, asking me how as wife, professional, and mother I could fit it in to train.
It is a hard thing to realize or admit that certain dreams in life won’t come to fruition. It is also no fun to do so.
So, I squat down stubbornly and make a pose like a downhiller. Even though my knees crack when I stand up, I’ll still pretend that all it will take is a little practice. Or maybe, I’ll try cross-country skiing. That’s something I can train for with our daughter in a backpack.
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