Category Archives: Photos

Ireland, part 5

Another excerpt from my travel journal, dated Monday, April 14, 2008:

Early the next morning we were off.  Before leaving Dingle Town we’d picked up some sandwiches, post-cards, and woolen souvenirs. The highlight of the trip to Galway was a thirty-minute ferry ride in the crisp, cool sunshine.  The cold wind blew across the sound as we huddled on the upper deck of the ferry to enjoy the view.

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The next stop was the Cliffs of Moher.  I properly waited behind the fence while David ventured with others onto private property for better photographic opportunities.  The sun shone brightly on the green hills and turned the water into silvery waves lapping at the foot of the cliffs far, far below.  We ate a picnic lunch on some steps before admiring a tower and continuing our drive through the rugged and barren “The Burren” with its treacherous roads to Galway.  (Cliffs of Moher picture belows, and my masterpiece panoramic in the blog’s header.)

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We arrived at Galway during rush-hour traffic and checked in to Eddie and Helen’s Four Seasons Bed and Breakfast near Eyre Square.  We wandered down to the town center, had dinner of sub-prime lasagna and sub-prime Chianti (David, on the other hand, had excellent roast duck quessadillas), explored the waterfront, and then enjoyed a pint at a crowded pub which featured a piper, three violinists, and an accordian player who might have been carrying a staff and garbed in a grey woolen cloak on a normal basis.  Eddie had told us we’d have to “find the crowd,” and his one piece of advice had been to “follow the short skirts, lads.”  Well, I didn’t see many short skirts in the warm, jolly inn, but there were many a person enjoying the folk music, fellowship, and satisfying drink.

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Tuesday, April 15, 2008:

I could tell David was slowing down as he pushed his sausage and hash around his plate.  We were downstairs the following morning enjoying a big breakfast–an omelette for me, and a full Irish breakfast for David.  He’d already supplemented his with a wedge of cheese, toast, tea, and fruit salad.  Partially not wanting to waste food, and partly wanting to see if he’d really do it, I challenged him to finish everything on his plate.  He did, surprisingly and nauseatingly enough, and I gave him the 10 euro as promised in our bet.

The day was spent reading and relaxing–at a tea shop, near a 1960s stone cathedral, and on the quay.  We had a light supper of sandwiches and then a pint at the sophisticated and masculine Skiff Hotel with its dark wood paneling, fireplace, and numerous staircases and balconies, right on the south side of Eyre Square.

This picture is either at the tea shop or at the sophisticated and masculine Skiff Hotel, I can’t remember which.

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Sitting on the quay in Galway in the late afternoon sun.

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Columbia & Jazz

I’ll have to write more later about the nearly three weeks I have spent as ICU senior (or “junior fellow”) in the surgical and cardiothoracic ICUs.  The days are packed with intensity, from unstable patients, to hectic call nights, to diagnostic dilemmas, to withdrawals of care.  Add to that the month of August (only one month into the medical new year) with its fresh interns, and my job becomes that much more difficult.

After nearly no sleep on Tuesday night but finishing my shift with a relatively stable 21-bed cardiothoracic intensive care unit, I crashed at home well into the afternoon.  I ventured out only late in the afternoon to get some tile sealant and sticky mouse traps.

I will spare you, gentle reader, the details of catching yet another mouse, and there’s really no need to mention how a friend told me about the humane execution method of drowning the struggling rodent in a bucket of soapy water.  No, the average Mulberry Street vistor will have no interest in knowing that the soap does wonders to the surfactant lining those rapid little lungs, but she, in her sensibilities, and if pressed, would admit this does seem more humane than throwing the critter away live, whiskers tucked back, the thin rope of a tail flicking yesterday’s can of tomato sauce.

Instead, I thought, how much better to share the pictures I took as I sauntered around Columbia’s magnificent urban campus in the slant of the late afternoon sunshine, and later, as I lounged with other Harlem residents at the foot of Grant’s Tomb as we listened to live jazz in the perfect summer evening.

The lower plaza, with Butler Library to the right.

Alma Mater“, her back toward the grand Low Library.  The university’s architect worried initially about what kind of statue would be placed in front of his masterpiece.  Upon the unveiling, however, he was pleased.

A corner of the upper plaza, with 116th Street separating the upper from the lower plazas.  One of the most incredible urban spaces in New York City.  I like the patches of green beside the fountain.

The grass had an otherwordly green hue in the sunlight.

The picture also seems effective in black and white.

Approaching Grant’s Tomb.  The week before, I was lured over from nearby Sakura Park by a jazzy version of “Over the Rainbow.”  I am a sucker for “Over the Rainbow.”  Versions that grace my iPod include those by Katharine McPhee, Ray Charles, Iz, and Eva Cassiday.  The instrumental version was really cool.

My Harlem neighbors enjoying the jazz.

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Family pics

When I was home recently in Texas, I took some family pictures…

Here are Mom and Dad at Dad’s office in Kilgore.

My five-year-old niece Isabella.  She likes to go to sleep surrounded by her favorite dolls.  I suggested the miniature horse could nuzzle her pillow, and my sister Shelley informed me that since that visit, Isabella insists on the horse being beside her.

Helping brush Isabella’s teeth.  Brushing teeth is apparently much more fun when Uncle does it.

Tucking six-year-old nephew Roman in for the night with his Elmo pillowcase.

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Ireland, part 4

From my travel journal, dated Sunday, April 13, 2008:

Breakfast this morning was more to my New Yorker sensibilities: coffee with a toasted bagel with cream cheese and smoked salmon.  We drove the 3/4 mile into town and set about renting bikes.  Alas, closed were Paddy’s Bike Rental; Foxy John’s Hardware, Pub, and Bike Rental; and the Mountain Man Bike Rental.  Eileen’s Bed and Breakfast had only one bike for rent.  So deflated were we that we didn’t even bother checking Atheist Jack’s 24/7 Bike Shop.  Thankfully, we had a back-up plan for touring Dingle Penninsula: our trusty Mitsubishi Colt.

Retrospectively, given the length of the ride (30 miles) and the numerous hills, this was probably no unhappy occurrence.  It was, then, in climate-controlled and lumbar-supported comfort that we reset the odometer and headed west out of town.

The stops are too numerous to try to recall each individually.  One early one was a ~1,500-year-old fort, clinging precariously to the edge of the cliffs, surrounded by choppy waves breaking on boulders far below, and by stunning greens and blues in the morning Irish sunlight.  The fort was preceded by a series of one-meter embankments, on which we attempted to get some sheep to cooperate with our photographic inclinations.

At another “pull-out”, we scrambled ten meters or so below road level to a rock protruding out above the ocean.  A little dirt path told me it was safe, and thus it was difficult to imagine any danger or other untoward event.  However, had the path not been there, my sensibilities regarding slippery rocks, a long fall, large boulders, and socialized medicine may have produced a moment’s precautionary hesitation, if not prudent abstention.  It was at this stop, I think, that the Colt achieved elevated status as a companion and a personality.  We began to try to include it in rugged, scenic photos when at all possible. (Colt post to come.)

One of the more memorable stops was near the Great Blasket Islands.  On these, off the westernmost tip of Europe lived about 160 people at most preceding World War I; the population dwindled to fifty and then twenty by the time there was a forced evacuation of the island in 1953.  The farmers used to row thirty minutes in to a beach and then hike 12 miles in to Dingle Town to sell produce.

After visiting the sleek, multimillion dollar Great Blasket Centre, however, I learned that the Great Blasket Islanders’ true passion was melancholy storytelling and mourning a vanishing way of life.  Irish was primarily an oral tradition for several hundred years until the late 19thCentury, and it was then, about 100 years ago, that the Islanders began to record their history in pen and ink, and to wistfully remember it.  The irony is, best as I can tell, that all the sad clinging to the scattering pages of their ancestors’ lives; the fading solidarity with the harsh and rugged landscape, the soft peat, the vast sea; the lilting cadence of the speech and stories…all this mourning and remembering and wistful recording began a good generation or so before the island population’s decline.  The island sons’ and daughters’ departure for a better life in Dublin, London, or even America; the forgetting of an ancient tongue; the lure of better jobs for the midwife in a modern inland clinic, or for the farmer in the rapidly sprouting technology corridor of the city; this was all the result of a self-fulfilling prophecy on the part of the self-conscious writers.  They did not preserve the culture; they killed it.  I hope you’re happy, Thomás Ó Criomhthain, and Muiris Ó Súilleabháin.  May you rest in peace, just as your culture now rests in peace, Peig Sayers.

I might add, also, that the Great Blasket Centre had a very nice seafood bisque and some of the best Irish brown bread I’ve had here.

One of the final stops was an ancient Norman church built ~1200 AD; in the front yard was a 6-foot stone dating from ~300 AD with a hole near the top.  This was a sacred pagan site before the arrival of Christianity.  Two parties would place and touch their thumbs through the hole as a means of making a vow.  To this day, wedding vows are renewed in this manner by some.

Departing from my usual habit, I had the urge to place a penny in a spot where, upon returning in years hence, I might find it once again. So there, to the right of the second arch, just above eye-level is a crack that now hides a little copper penny.

We coasted back into town and took an hour nap with the window open, sunshine streaming in, and a slight breeze carrying the distant bleating of sheep to make one of the best naps I’ve had in quite some time.

And then, feeling that Rick Steves might be disappointed in our not making the most of the day, we drove into town were I sat by the docks and journaled while David did some souvenir shopping.  And to further redeem the afternoon, we walked along the harbor by the water-front all the way around to the old tower.  A dog we named Blackie followed us most of the way there and back.  From a mossy perch seated near the tower with its nearby rabbit holes and briar patches, we could look out as the sun set across the harbor, and we even spotted Fungie, a dophin that’s lived near the mouth of the harbor since 1981.

Dinner was at the nearly empty Blue Zone Jazz where we split a delicious thin crust pizza with Italian ham and mushroom, with a glass of red wine.  Next door was my favorite pub yet: dim but not dark Dick Mack’s, formerly a leather & shoe shop by day and pub by night.  There we met an anthropology student from Pittsburg who’d strangely acquired an Irish accent during his time abroad, as well as two men who grew up in Dingle Town but now work in larger cities.  They made jokes and we laughed, only catching 3/4 of what they said at baseline, and even less when they were laughing.  Maybe they were laughing that we were laughing when we didn’t understand them.

A word about the pub–being across from a church, it had the nickname, “The Last Pew.”  It opened in 1899 and the interior can’t have changed much since then.  One wall was filled with leather shoes, some in boxes, some atop the long wooden shelves which climbed twelve feet or so to the ceiling.  In front was a counter, on either side of which patrons could sit.  One side had an array of stools, while the other featured simply a long wooden bench.  There was the bar, of course, on the other wall, as well as a couple cubby-holes or nooks for quiet conversation, or, for the demure ladies in town, a discreet drink.

“Is it alcoholic?” I asked of the two men who chatted with David and me, referring to the pint of golden-hued Bulmer’s cider, its crisp coolness accented by tiny bubbles curling their way ot the surface.  “Aye!!! Nothing like a coupla’ these after a hot summer’s day!” enthusiastically replied one of the men, and then lapsed into a round of hearty praise for the drink, in either Irish or unintelligible English.

Addendum (June 10, 2008): In my estimation, this pub, with it its cozy atmosphere, quirky wall of shoes, ample hard wood, history, and fun nickname earns the prize for my favorite pub visited in Ireland.

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Ireland, part 3

From my travel journal, dated Saturday, April 12, 2008:

Some things will stay with me after I leave Ireland–the pastures green under cloudy skies after a soft afternoon rain, the rugged western coast tumbling down to the breaking waves below, ancient stone fences and woolen dots speckled on the mountainside, and the warmth of the friendly locals.  But on this day, what stayed with me most were memories of the full Irish breakfast I ate.  I could feel it, for eight hours or so, in the pit of my stomach, the two juicy links of sausage, the glass of juice, the slices of ham, the buttered toast with marmalade, the over-easy egg with a generous sprinkling of pepper, the coffee with milk and sugar, and, not least, the two patties of black pudding, an Irish tradition made from pigs’ blood.  Like patê , I probably would have enjoyed it more if I hadn’t known what it was.  David liked the blood sausage; I, recognizing the importance of keeping traditions, will be happy to let the Irish keep this one.

Thus, with loosened belts and lightened spirits, we set out for the Killarny National Park and the Muckross house, dating from the 1830s.  David and I stopped by the public W.C. which was being freshened by the cleaning lady.  His uninhibited bladder led him right in; I discreetly used the single restroom with luxurious grab-bars, a strangely low sink, and a curious ancient Irish symbol which resembled the profile of someone in a wheelchair.

Approaching the house, it was hard to resist the jaunting cart driver’s offer, “Would you like to hire a horse, lads?” Everything just sounds more appealing when they call you “lads.”

The house had a beautiful green lawn stretching to a protected cove off Muckross Lake.  I thought it interesting that the carriage entrance was at the side of the house, leaving the large entertaining rooms to face the lawn and the water.  The tour was interesting, especially seeing the shields on stands near the fireplaces to protect the soft wax on women’s faces, as well as hearing the story of Queen Victoria’s visit.  The house cost thirty thousand pounds to build, but the owners took six years and took out a sixty thousand pound mortgage to prepare the house for the queen’s arrival for a one-night stay, with hopes of being given titles, and thus increasing their wealth.  Prince Albert died just a couple months after the visit, and Queen Victoria never got around to bestowing a title.  Muckross House was repossessed and eventually sold, the owners helplessly in debt.  The lesson: Be content with what you have (especially if it’s a fabulous mansion on a secluded Irish lake); or, if that lesson isn’t enough, then remember that the English will get you every time.

Afterward we began hiking.  David thought we were on the wrong path, but I became increasingly convinced that we were headed toward the Meeting of the Waters.  The topography of the Torc Mountain (seen in above photo on left) and its appearance on the contour map assured me of my bearings.  We were each so sure of our respective positions that we bet a pint–and then David upped it to two–which he later discovered he owed me.

We made it to the Meeting of the Waters, which sounds like a magical place–the sort of clearing from which Frodo and Sam might set off, where Boromir might die, perhaps where Aragorn may even have a kingly vision or dream of Arwen.  In realty, the Meeting of the Waters looked more like a curve in a stream.  Only with a good map eye, a sturdy foot on rocky trails, and a dash of imagination could one envision this place being out of the ordinary.  We’d come 4.5 kilometers not to see the curve of a rainbow on shimmering golden water, or even a water nymph in a gossamer gown, her slender bare arms playing a small lute, her chestnut hair pinned up at the nape of her neck, her pale skin white against the rose of her small pouty lips.  No.  It was a bend in a creek, with a nearby coffee and pastry shop with picnic tables out front.  David, sharing in my disappointment, suggested the name should be “A Meeting of the Waters,” or “The Meeting of Some Waters.”

On completing our nearly 4-hour hike around Muckross Lake, we walked up the lawn as dark clouds rolled above the manor.  And then, to my delight, the sun emerged and lit the house in a brilliant yellow beneath the angry clouds.  I’m proud to say I caught this moment on my digital camera. 

It was easy to refuse a jaunting cart ride this time around as the parking lot was only 100 meters away, and we’d just walked nearly ten kilometeres.  With a small square of Toblerone and a newly purchased disc of Irish jigs and ballads on the car’s stereo, we were on our way to Dingle Town.

There, we checked in to the Bed and Breakfast with Mary and admired the view of pasture, bay, and tower from the window.  Dinner was at John Benning Moriarty’s (Beef & Guinness stew with a Smithwick’s for me) with some out-of-tune accordian, guitar, and Irish bagpipe music.  We  walked over to the Small Bridge Bar where I had a pint of Harp and we were able to sit close to the skilled violinst & recorder player and guitar player, finishing the evening with a little good Irish craic.

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Time travel’s paradoxes

While discussing Harry Potter and the Prisoner of Azkaban with me, my roommate Jordan mentioned that there was an irreconcilable paradox presented in the book.  The story is as such: Harry is about to have the life sucked out of him by the dementors when a powerful wizard across the lake casts a hefty patronus spell to ward off the dementors.  In his fleeting moments of consciousness, Harry believes that it was his now-deceased father who appeared and cast the spell.

Later, Harry and Hermione travel back in time to save “more than one” life.  Harry of the Future eventually finds himself across the lake, watching Present Harry getting succumbing to the dementors.  He tells Hermione that his father is bound to appear any moment to invoke the patronus.  However, at the last critical moment, Future Harry himself steps up and wards off the dementors, thus saving his own life.

Up until that point, Harry had been able to produce only a very feeble patronus.  He later states that at the last minute he knew he could do it because he had seen his own patronus.  Thus, disaster is averted, and all ends well.

I might point out a few–shall we say–internal difficulties this plot presents.  Of course Future Harry knows the future of Present Harry, but in his confidence-building realization that he had seen his own patronus, we realize that Present Harry across the lake had witnessed the future of Future Harry.  In other words, in that moment of clarity, Present Harry encountered Future Harry’s future, and that gave Future Harry confidence to act.  I’m still struggling to get my mind around this, but it seems ironic to say the least that Present Harry (who had not yet time-travelled) could have any insight about the future.  This is probably why the professor wisely told Michael J. Fox to avoid himself in Back to the Future.

Another paradox arises, and this is the fact that Harry could create a powerful patronus because he had seen himself do it.  This is a classic chicken-and-egg scenario.  Which came first, Harry’s patronus or his confidence?

Lastly, and this is where things really break down, it is clear that Future Harry saved Present Harry’s life.  Future Harry could only travel back in time because Present Harry had lived.  Had Present Harry died, there would be no Future Harry.  In other words, Present Harry’s living depends on Future Harry’s acting which in turn depends on Present Harry’s living.  If this were a choose-your-own-adventure book, this branch of the plot is dependent on that very branch curving back on itself and inserting a branch point.  (Sorry for the mixed metaphor.)  I suppose this may be J.K. Rowling’s implicit argument for a divine presence, but I think it would be much more intellectually satisfying had Future Hermione saved Present Harry’s life.

For those who do not find this discussion compelling, perhaps you will be deeply moved by this Prohibition Era photograph.

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Things I don’t like

After an exceptional day in the operating room, I realize this list is definitely due, and perhaps will be added to over time.  It focuses on my dislikes at the hospital.

  • Standing on power cords.  This robs me of my sense of stability and balance.  It’s remarkably uncomfortable.
  • Trying to put a forced-air warming blanket on a patient after the surgeons have draped.  Although this causes me no direct pain, it is amazingly annoying and inconvenient, especially compared to how easy it is to put on the warming blanket before draping.
  • Pushy surgeons. Surgeons are pushy for a number of reasons, but they usually fall under the categories of 1) Shortsightedness, 2) Rudeness, and 3) Bullheadedness.  I will further explore these in proceeding bullet points.
  • 1) Shortsightedness.  Often surgeons are pushy because they want to get the case started.   They believe that the extra ten minutes it took me to get an EKG before bringing the patient in the room because their patient was not adequately prepared is somehow MY delay and this gives them the right to be pushy.  They do not realize that I am trying to HELP them take care of the patient, that it is THEIR fault the patient was not adequately prepared (Why is it so hard for a medical doctor to realize that a patient with coronary artery disease needs an EKG before surgery???), and that if something bad happens because a patient was not adequately prepared, it is MY fault legally because I succumbed to their pushiness.
  • 2) Rudeness.  This happens far less often than it used to, but I’m still amazed at how a surgeon will stroll in and INTERRUPT my interview with a patient without even acknowledging me.  I am a physician, and this shows absolutely no respect. I have a policy now of either saying, “Excuse me, you just interrupted me,” or just leaving, telling the surgeon on my way out, “I guess I’ll come back when you’re finished.”  This will usually bring an apology.
  • 3) Bullheadedness.  Please do not tell me that I need to transfuse blood or start an arterial line when any anesthesiologist would balk at exposing a patient to unnecesary risk.  If you understood the valid medical reasons for doing things that anesthesiologists do, and if you presented such a reason in a nonconfrontational way, then sure, we can talk about it and consider it.  But when you are bullheaded about wanting me to do something stupid, and I choose to be neither bullheaded nor passive-aggressive back to you, then that is not time to persist in your bullheadedness.
  • Loud noise.  Today we had jackhammers in an adjacent floor for the better part of the day.  The subway workers manage to work at night and the weekends…why can’t hospital construction workers?
  • Loud noise.  Nurses with loud voices deserve their own bullet point.
  • Loud noise.  Surgeons with loud iPods get another bullet point of their own.
  • Lack of awareness.  There are critical times in surgery.  I do my best to focus with the surgeons at these times.  From my end, induction of and emergence from general anesthesia are critical times.  This is not the time to laugh and joke and turn up your iPod.  I will ask you to turn it down.  And I notice the surgeons who stand quietly and attentively at the bedside while I induce and intubate a patient.  Often, those are the surgeons I would choose to send my family to.
  • Making a mockery of safety.  During the surgical “time-out”, I stop what I’m doing and actively listen, often voicing agreement afterward.  Surgeons who do the time-out with the attentiveness of a 6-year-old in church scare me.  They seem to think that operating on the wrong side of the body is a thing that happens to Other Surgeons.
  • Nurses who do not listen during report.  I may have just spent eight hours ensuring that a patient lives through anesthesia and surgery.  I may have even made a little extra effort to make them wake up without pain and nausea.  Sometimes I take steps to prevent untoward cardiac and pulmonary complications.  If I feel like it, I manage the patient’s fluid balance and blood counts.  I listen constantly to the beating of their heart, I watch the contours of their arterial pulsatility, I monitor the electrical activity of the heart.  I pad pressure points.  I secure arms so they don’t fall.  I paralyze patients and reverse the paralysis.  I make sure necks stay neutral.  I tape eyes closed–sometimes with lubricant inside–to make sure their are no corneal abrasions.  I suction out the stomach to prevent nausea and aspiration.  I measure urine output.  I keep my patient warm.  I comfort and assure patients immediately before surgery.  I answer questions.  I introduce myself to family members.  If after doing all these things I want to take two minutes to tell you about OUR patient, please take the time to listen closely.  After all, I might tell you something important.
  • The Emergency Department.  This is the most chaotic, most terrible place in the hospital.  I cannot imagine my hospital’s ED ever being called secure, controlled, stable, or peaceful.  There are sick bays.  There are stretchers lining the halls.  There are large families crowded around loved ones.  There are people there for marginal complaints.  One’s attention is constantly pulled from one thing to another.  Here, one will encounter that ghastly combination of ADHD physicians, type A aggressive nurses, puking patients, blunt security guards, and a constant, rumbling cacophany.
  • Lack of professionalism.  Just because you are a surgeon doesn’t mean you need to curse in every sentence.  Just because you are a surgeon doesn’t mean you need to talk about your sexual conquests in the operating room.  Just because you are a surgeon doesn’t mean you need to talk about how your patient is too fat, too hairy, too ugly, or too annoying.  I will stand up for my patient.
  • Scrubs that do not fit well.  Just because more than 50% of Americans are overweight does not mean that scrubs should be designed in “square” proportions.  (Small = small waist and short legs, XL = huge waist and long legs.)  I cannot stand bunching up my wasteband and a crotch seam that comes down to my knees; nor can I stand legs that are too short.

Wow.  This post is far longer than I intended it to be.  The feelings just kept coming!  And the picture, if you’re wondering, relates to the last bullet-point.  I thought it was worth a smile!

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