A WORK OF ART

"A guilty conscience needs to confess. A work of art is a confession."
-Albert Camus



One of the most important things in life, if you ask me, is art. Whether it be music, painting, literature, or even dance, art has the ability to transform the way one feels and thinks. The foundation of much of civilization has rested upon cultivation and appreciation of art, and I can identify with that. I am not sure exactly when an interest in art developed in me, but I love most modes of art.

My favorite art form is music, mainly rock but also classical, bluegrass, world music, etc. My friends have been instrumental, no pun intended, in turning me on to various bands- the Smiths, Soundgarden, Martin Sexton, Jeff Buckley, etc. However, I discovered one of my current favorite bands, Bon Iver, all on my own. The lead singer is Justin Vernon, and their album "For Emma, Forever Ago" was hailed by many as the best record of 2008. I could not agree more. A clip of an impromptu a cappella performance of their song, "For Emma" in a hallway in Paris may be found here.

This song never ceases to amaze me or move me, and I think it is because there is a confessional quality in Justin's words and notes. I do not know exactly who "Emma" is, but I feel like I know her. Perhaps that is the true measure of great art- reaching the audience and bringing them into the artist's world while they also bring the artist into theirs.

A "JANUARY PICK"

One of the people about whom I have not written extensively in this blog is my wife Kathleen. We met a little over 10 years ago in January, 1999 when I was an intern and she was a 3rd year resident in Dallas. She was very good friends with my senior resident, and she stopped by our team room to talk to her friend one day. (Of note, when I interviewed in Dallas as a 4th year medical student, about one year before that, I went on rounds with her team, although she and I did not really converse at that time. I do remember thinking she was cute, though). That day, in the rounding room, when we met for real, I realized we had several common interests: running, movies, and a love of literature. I had started a book club as an intern for the express purpose of meeting women, so of course I asked Kathleen to join us. We were reading "The God of Small Things" by Arundhati Roy. Shortly thereafter, we started going out, and on our first date Kathleen was at my place and asked me if she could use my phone for a long distance phone call. I said yes, and she called her future boss, Craig Nichols in Portland, to accept a Heme-Onc fellowship position for 1 year from then. Neither of us expected that our relationship would progress to anything substantial in that time frame... or so we told ourselves.

However, as we continued to date and the time came for Kathleen to move to Portland, it was clear that we had strong feelings for each other. We decided that Kathleen should still go, but we decided to make a go at a long distance relationship. The first 2 years were spent between Portland and Dallas, but in the final year of our separation, I was in Baltimore for my own Heme-Onc fellowship. I guess 1/2 a continent apart was not enough of a challenge for us! We somehow survived those 3 years apart with a mixture of nightly phone calls and Q4-6 week visits. Nonetheless, I would not wish a long distance relationship on my worst enemy. Anyway, Kathleen relocated to Baltimore, and we were married shortly before her arrival. We eloped and got married in City Hall in Manhattan. Why NYC? You could say too many Woody Allen movies, but, in our minds, if one is going to elope and get married in a city hall, shouldn't it be in NYC?

We lived together and worked very hard during our first 2 years together in Baltimore; I was in the lab, and Kathleen was in private practice in Annapolis, MD. We spent weekends in D.C., Philly, NYC, or at home. We went running together, biking together (including a hellacious bike trip through the ghet-to, but that I will leave for another time), and enjoyed the company of friends. I knew she was an amazing friend and wife, but I do not think I truly came to appreciate her until the day our son was born, and I almost lost her.

One day past her due date in July, 2005, she went into labor on the way home from a full day on her feet in the hospital. Despite the fact that the July intern on call tried to convince her that maybe she had just an episode of incontinence rather than her water breaking ("um, there were chunks," thank you), we went into the hospital for a prolonged bout of labor on pitocin, which is used to stimulate uterine contractions. Sixteen hours later and after a failed epidural for much of the night (it was finally replaced by an Anesthesia attending before shift change at 7AM- remember folks this is July with new housestaff in the hospital), the decision was made to deliver our child with forceps. He came out, and we were both in tears. Shortly thereafter, Kathleen felt faint; her blood pressure had dropped, and she was having profuse uterine bleeding. The cavalry came in, and she was resuscitated.

I have never been so scared in my life. A lot went through my head in those interminable minutes. How could a moment of utter joy turn into such a nightmare so quickly? How can they not get IV access? Where is the central line kit- I will have a line in in 2 minutes! How can I possibly lose the woman whom I love more than any whom I have known who has just given me a beautiful son? Fortunately, the bleeding stopped, and Kathleen stabilized, but not before she had lost 1/4 of her blood volume. We took our little boy home together just 2 days later, which is a tribute to her resilience- she elected to take oral iron and refused a blood transfusion; I told you she is tough.We have since had another child, little Cate.

I must say that as much as I had appreciated Kathleen before we had children, parenthood has helped me realize how lucky I am to have found her and married her. As much as I love the kids, this is dwarfed by her devotion and selflessness to them. Perhaps this comes from having carried each of them for 9+ months, but I think it is deeper than that. She senses that this is the next phase of our lives together, and (like everything she has done in her life which she has valued: family, science, medicine) she is giving her all to it. The loss of her own mom when she was a teenager probably left her with an understanding that we are here "until further notice" and that everyday is a gift. No one need remind her of that on a daily basis.


This was best exemplified when we were in Vancouver 2 weeks ago. A friend had recommended a great Indian place called Vij's, which is called "the best Indian restaurant in North America." Kathleen dropped me off at the front around opening time for supper while she parked the car with the kids. Miraculously, there was an opening, and I was seated. I quickly discovered by looking around at the decor and clientele that this was not a highchair and kids' menu kind of place, and I wanted to make a run for it. A few minutes later Kathleen arrived with the kids in tow. She sensed my unease, but she just smiled and said that no one was asking us to leave and that it would be okay. She helped entertain little Cate and filled her with Cheerios until she was calm/sated. It was the best Indian meal I have had in my life (sorry mom!): BC spot prawns and halibut with black chickpeas in coconut-lemon curry and beef short ribs in cinnamon and red wine curry with warm greens. Kathleen was right; we all survived the meal intact... thanks to her.

To summarize how I feel about my wife, I turn to a political analogy I heard for the first time last summer when the respective nominees were considering running mates. There was talk of the advantage of various candidates and what they would bring to the ticket. There were "September picks", ones who would provide a huge bounce out of the convention but not necessarily win over voters on election day (see Palin, Sarah and think one-night stand). There were "November picks," ones who would win over a crucial state or demographic group (see Clinton, Hillary and Palin, Sarah in Senator "Hail Mary" McCain's wildest, most drug-addled dreams and think fling), and there were "January picks," ones who might not move a single voter into one's camp but who would allow the President to govern most effectively throughout his/her term (see Biden, Joseph and think partnership). What I have discovered (and which I try not to forget) is that my wife is a "January pick" through and through. While I loved our care-free dating days and newlywed days, her true character, strength, and resolve have been most apparent since we left the B.C. (before children) phase of our lives. Nicholas and Cate could not have wished for a better mom and I a better wife and best friend.

CUTTING FOR STONE

I recently finished the new, debut novel by Dr. Abraham Verghese entitled "Cutting for Stone." In ancient times, "cutting for stone" was the act of surgically attempting to extract mental illness/madness. The Hippocratic Oath, which I, myself, took 11 years ago (has it already been that long?) states that one will not do this. Those Greeks were wise!

I first became acquainted with Abraham Verghese in 1994 when I was a medical student in Houston. He gave a lecture, or rather a reading, from his first non-fiction book, "My Own Country." It is the story of an Ethiopian-born physician of Indian descent who came here on the "cowpath to America" to do residency training in a small, rural hospital in Tennessee populated by foreign grads; he had no other opportunity. He went on to do his Infectious Disease training at Boston University, a pre-eminent center in its time. Subsequently, he returned to rural Tennessee, and "My Own Country" chronicles his life and practice there as someone, like the young, gay men with AIDS whom he treats, who has never had a place of acceptance, a home, a country to call his own. For me, it was not until medical school that I found a community to which I truly felt I belonged (see Amit, Asim, Donohue, Swurz, Chap, etc).

His second book, "The Tennis Partner," details his friendship, played out on the tennis court and beyond, with a medical student who is a recovering drug addict. I had the good fortune to hear Abraham read from this at the Dallas Museum of Art during my residency and to meet him afterwards. He was every bit the gentleman and inspiring figure I imagined he would be. In many ways, this blog, my way of sharing and recording my thoughts on life, family, and medicine, springs from his example. .

"Cutting for Stone" is described as fiction, but the influences from Verghese's own life are obvious. The novel is set in Ethiopia and revolves around a set of twins born to a nun, Sister Mary Joseph Praise, who dies in childbirth in the opening section of the book. The man, who is presumably the twins' father, Dr. Thomas Stone, a legendary surgeon, hastily leaves the mission hospital, at which he and Sister Mary had worked closely together for years, in despair soon after her death. From here the novel recounts the story of the twin boys named Shiva and Marion Stone and their growing up in 20th century Ethiopia. It is a story about love: filial (the love of a son for his adopted mother and father and for the specter of the biological father whom he never knew), brotherly, and also romantic (the love of a young man for a young woman whose flame cannot be easily extinguished...despite her best efforts). It speaks to the power of this emotion despite class, race, and distance, and the strength of this emotion even within a young, awkward, persistent teenage boy who felt he had found someone special (Been there, done that).

I will not "spoil" the story, but when I closed the book after reading the final page on a transcontinental flight back home to Portland, I had tears in my eyes. I cried not only because of the beauty of Abraham's words but also because someone had written something so personal and yet which I found to be so resonant of my own life, my own thoughts, and my own story. While I respect the critics in the New York Times Book Review, there is an intangibility, a transcendence in Abraham's writing that may be lost on experts of literary criticism but which is not lost on those who have felt like they were on the outside looking in for much of their lives. It is my belief that it was for us that "Cutting for Stone" was intended.

THE BOY WHO WOULD BE KING

Today my first-born, aka Mr. Nicholas, sporting the crown above turned 4. It is hard to believe that he was born in 2005 after a very, very long and scary labor. It seems like yesterday when I first held him in my arms as tears streamed down my cheeks. He has become quite the young man since that time, and, as much as one's lifestyle takes a hit after kids, I could not imagine my life without him.

He has taught me a lot in the past few years. Principally, stubbornness and particularity are family traits, and love knows no bounds. I am sure I will have the same feel for little Cate, who turns 9 months tomorrow, as she begins to take form and grows into the person whom she will become. I have always been a very teleological person, sort of an anti-Siddhartha (another would-be king- see Hesse, Hermann), but my children and a day like today remind me of the importance of enjoying the journey and taking it all in. There is joy in that!

EVOLUTION

A common trait among higher order organisms is the capacity for motility, which did not happen overnight. As you can see little Cate has evolved from a precious little lump into an on-the-go 9-month old girl. Watch out!

WHAT'S IN A NAME?

Last week, I attended my first City Council meeting as a concerned citizen. Of what was I concerned? There was a proposition by a Portland Planning Committee to rename my street, 39th Avenue, to Cesar Chavez Blvd. A hearing was scheduled for that night, and the Council was to vote 2 weeks later. I was not in favor of the move mainly because I thought it would be a pain in the ass to change all of our legal documents and not so much due to the intended honoree. In fact, I was opposed to renaming my street JFK Way, Obama Ave, or anything else for that matter. It was a classic case of NIMBY, Not in my backyard.

The City Council chambers were full with 2 distinct groups of people: young, brown people and older, white people. I was one of the few "crossovers." There were polarizing forces on both sides: the ardent pro-Chavez ("Cha-vez") folks thought this was pay-back for decades of racism, and they thought re-naming 39th Ave, which is predominantly residential and runs almost exclusively through parts of town populated by white people, would be a way of sending a message. Many on the other side proposed that a park, a farmers' market, or a community center would be more fitting. The worst of the "Save 39th" crowd said that they should name a school after Mr. Chavez ("Shav-ez" in their Anglo speak) because "maybe it will teach those people how to speak English." I must say my perception of the process and Portlanders grew increasingly negative after 3 hours of waiting for my turn to speak.

However, when my time to speak came, I had a greater appreciation for the moderates on both sides. My arguments, summarized below, reflected that sentiment:

"I have lived in 6 other cities and many of them had streets named after MLK or Cesar Chavez ("Cha-vez," thank you), but that did not make them tolerant. In fact, Portland is the most tolerant city, in which I have lived, but I don't feel that tonight. None would argue that Mr. Chavez is not a hero, and none would argue that there has not been discrimination in this country. However, how do we and you (the City Council) move forward and honor Mr. Chavez' contribution and all of our citizens contributions?

We honor Mr. Chavez and all Portland's citizens by promoting tolerance and diversity, by bringing all concerned parties together to find a solution. What an example for our kids. Isn't this what President Obama, whom many have channeled tonight, did in 2008? Isn't this what Cesar Chavez did? Make a lasting and worthy impact and move this city forward by honoring all its citizens including the 90% of residents of 39th Ave who have proclaimed their disinterest in having their street renamed in a recent City of Portland survey.

This is not a black and white issue; this is not a brown and white issue. If symbolism is your goal, be bold and make a lasting impact by naming/building something new, such as the new bridge spanning our river which unites both sides of the city. Unite activism and democratic sentiment! Whatever you do, consider the whole community! Isn't that what Cesar Chavez would have wanted? Isn't that what both sides of this issue want?"

With that, I left the lectern and walked out into the cool night air of the city... that I still love.