Shabbat Shalom

The elevator doors closed

the little cube of a room

I’d raced into after seeing

them open on their own.

And once inside, the yellow ceiling light

and the polished warm-hued trim reflected

the small orange button I pushed

for floor 10.

Only when the miniature fires inside

buttons 3 and 4

lit themselves

did I realize I had boarded the

Sabbath elevator

and thought that seven extra stops

made for a nice number,

an unexpected rabbinical ride.

~

This vertical ride, I thought,

reminded me too of the subways,

just off by 90 degrees or so,

when the express train

snakes local,

and nobody bothers to tell me in advance

that the A train leaving Harlem’s 125th

would stop at 116th, and 110th & 103rd of course,

and fail to bypass 96th

before slowing at pleasant 86th Street,

and pausing at 81st to drop off

museum goers anxious to see the dinosaur fossils.

And what’s one more stop at 72nd

before reaching the usual Columbus Circle-59th?

I will never look at these

seven extra stations the same way

but will instead offer a quiet prayer of thanks

for their underground burrows

teeming with rivet and rodent and tile.

~

Indeed, life offers many

unexpected stops–many knots along its

coiled rope of time.

Perhaps if I could roll the paired dice

of urim and thummim,

I could always avoid the flight

with the unanticipated layover,

the homeless man around the corner

who will ask me for a quarter,

even the slow line at the grocery store

that looks deceptively short.

No, it may be better

to savor these little hiccoughs–

despite their sour taste–

and to realize that interruptions

are life,

even if it’s the M60 bus

hobbling from block to block,

its engine wheezing as it traces

its Parkinsonian route.

~

And so the elevator

groaned and shuddered,

yawning at every floor

with a breath as invisible

as every Cohen and Shapiro

that rode with me that evening.

And with the seven stops,

I thought of suffering and blessing,

of scrolls and incense,

and considered a wish of

“Mazel tov”

to my patient soon to give birth upstairs.

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A new Mulberry feature

Saturday finds me realizing this has been a week comprising mainly two things: work and opera.  In a first for me, I made two trips to Lincoln Center this week to enjoy complimentary tickets to the Metropolitan Opera.  I’ve come to the realization that if I don’t plan to live in New York City forever, I should take advantage of things the city offers, and one of those things is a world-class opera house.  And when the tickets are free–courtesy of my roommate Jordan–that much the better.

 Learning to enjoy the opera more has been a side-benefit of living in Manhattan.  Having strongly favored orchestral music in the past, playing in the pit in a few operas in college helped me to appreciate the genre a bit more, but it wasn’t until I moved here and made friends with several vocalists that the world began to open up to me.  That being said, I hope never to become that sort of freakish opera buff I overheard in Patelson’s the other week.  The kind that says things like, “Bartoli is to mezzo as Pavarotti is to tenor.  That woman is a machine, but a machine with feeling.”  Or, “The Zeffirelli production is creative, but it lacks the raw power and nuance of the staging I saw in the 70s.”

In between the opera, I’ve been working on the Labor and Delivery floor, placing epidurals for labor and doing anesthesia for cesarian sections.  This is my third call in a six-day period.  When I don’t get home before midnight from the opera, needless to say it’s been a tiring week.

The shows this week included Puccini’s Madama Butterfly and Verdi’s La Traviata.  Good, solid Italian opera.  Given that I have a few remarks for each, and given that I’d like to avoid a monstrously long post, I think I’ll post retroactively on each of those.

The new feature the title of this post alludes to is the tab at the top in which I offer a short review of the various cultural experiences I take in.  A bit indulgent and supercilious, I know, but the obsessive-compulsive part of me likes to make lists.

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Filed under Around town, Music

La Traviata

Tonight I got to return to the Metropolitan Opera for the second time in a week.  Tonight’s performance was Verdi’s La Traviata.

Nothing much needs to be said other than that Anja Harteros was amazing.  Her role anchored the opera, and the major problem was that her brilliant singing nearly always outshone the leading tenor, whose name I cannot remember and will not bother to look up.

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Anja Harteros

Zeljko Lucic played a believable father who sang with decorum and impeccable interpretation, his rich voice finely balancing Harteros’ in their Act II duets.  And the final treat was the Baron, sung by John Hancock, whose chocolate baritone voice soared even during group recitatives.  This one performance was enough to inspire me to follow these three’s careers.

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The exuberant party scene in Act II, complete with stremers, confetti, costumes, Gypsies, and a matador with five bulls.

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Madama Butterfly

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I got to attend this opera tonight with friends Adam, Sarah, and Wendy.  Adam and Sarah had tickets on the side of the Dress Circle (A little booth with a door and individual chairs), while my complimentary tickets were in the orchestra section.  We rotated seats during the intermissions, so we all got to enjoy the opera from different perspectives.

This was a wonderful performance by leading soprano Pat Racette.  I also especially liked the Consul Sharpless, played by an expressive Dwayne Croft, but the leading tenor was an understudy and not too memorable. The Anthony Minghella production was spare, modern, and at times exquisite.  This production opened the 2006-2007 season at the Met.  The film director created great effects with a wall of color at the back of the stage, a sloping ebony stage, brilliant costumes, and an expansive mirror hung at a 45-degree angle above the stage, cleverly allowing the opera-goer to simutaneously see the action from the front and above.

This is evidently the most-performed opera in America.  Why?  The American theme?  The music is vintage Puccini, but in my opinion the score doesn’t have nearly as many memorable arias as any Mozart opera or even some Puccini operas.

Butterfly’s son is three years old in the opera.  Often the part is played by a six-year old child, but Minghella opted to go with a bunraku puppet with three black-veiled operators.  Their skill was apparent, but the whole effect was a bit creepy and made it difficult to emotionally connect with the puppet, er, boy.

My last comment is that I was startled when I heard echoes of “Bring Him Home” from Les Miserables in the humming chorus.  Certainly more than coincidental, this musical similarity plays a similar function in both shows.  But let’s be clear: Madama Butterfly was written first.

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Butterfly’s opening scene.   This dance was reflected magically in the mirror above the stage.

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The wedding party ascending at the back of the sloping stage.

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Tonight it is enough

Beside the wilted head of lettuce

in the refrigerator’s neglected bottom drawer

are two soggy tomatoes, now with soft gray fur.

And in the corner of the bedroom,

the treadmill, 8000 model, stands forlorn–

being better suited to holding today’s casually tossed

shirt and pants

than to counting endless miles I did not run

in the park

or beside the river.  No, all it has to count is up to two–

one brown sock draped over the rail, its mate

flopped on the shiny black tread.

~

All around the apartment I can find

little reminders

of the best intentions that came

to nothing more than the letter I did not write

to Grandmother on the card-stock

with the New York Harbor photo–

its royal water taking in the morning sun

and glistening towers rising from the surf-slapped slate;

or the Ives sonata I never learned

which now gathers dust on the music stand.

~

Perhaps better not to look

at the New England guidebook still with price tags

for delightfully abstract weekend getaways,

the pristine crock-pot in the kitchen cupboard

with the slow-cooker recipes–to save

all kinds of money–

and the print I never hung–you know,

the one of the woolen sheep

herded up the steep slope with the Irish cliffs

tumbling down into the wild blue sea.

~

No, tonight it is enough

as I pad across the hardwood floors

of my bedroom–now October-brisk–

and crawl under the comforter I meant to wash

last week,

to be satisfied with the things I did do

and leave tasks undone to the morning

with its bright ambition

and bushy energetic tail.

Yes, there is another day to mop the kitchen floor

and finally open that 12-pack of

mint-flavor floss, six yards per roll.

~

Yes, I think Emily would understand,

as I reach past the tome of her Dickensonian rhyme

and with a click of the lamp,

send the room into dark, peaceful sleep.

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“A soft answer turneth away wrath…

…but a witty one can silence a fool.”

Living in New York City means living in close quarters with people who are at times cocky, arrogant, brusque, dismissive, and overbearing.  People do not sit on the front porch sipping lemonade here; they do not bring casseroles to new neighbors.  No, they run over others who happen to get in their way, they insult those in proximity who happen to annoy them, and they often have no regard for others they may be inconveniencing.

Thankfully, the hospital atmosphere usually smooths out the rough edges.  Usually.  I remember vividly when I was interviewing for residency at NYU, I stopped at the security desk and asked politely for a visitor name-badge.  That simple request at 7:30 in the morning apparently ruined that security officer’s day.

The other day, I was going to bring a patient back to the operating room.  One of the nursing assistants had already started an IV on the patient–a bit of a luxury at my institution.  I usually will just carry the bag of intravenous fluids as I escort the patient, but this time, without thinking, I started to push the IV pole with the patient as we headed toward the door of the preoperative holding area.

“I knowyou’re not taking that pole!” one of the nursing assistants said in a condescending tone.  I stopped, instantly feeling annoyed.  I usually don’t think about the medical hierarchy, but there definitely is one.  Attendings > Fellows > Residents > Interns > Medical Students.  Nurses have a bit of a different ladder, but I would generally place an average nurse somewhere between an intern and a medical student.  Interns write orders that nurses follow, but they are still credentialed professionals; medical students are not.  Otherwise, the nursing hierarchy is something like Nurse Manager > Charge Nurse > Nurse > Nursing Assistant.

As a senior resident (a chief resident at that) I intuitively feel I’m perhaps a couple rungs higher than this nursing asssistant.  And while rudeness (in the sense of condescension) is never professional, it seems particularly egregious when it’s directed up the ladder.

And so, I turned, and I said in the most neutral tone I could muster, “Are you asking me to leave this IV pole here?  Because if you ask nicely, I would be happy to.”  This was met with absolutely no reply, so I unhooked the bag from the pole, and escorted the patient out of the room.

On a different day, I happened to have a medical student on an anesthesiology rotation assigned to my room.  We were doing a complex case–a resection of a lobe of the liver for a living-related liver transplant.  The surgeons like the patients dry so the liver doesn’t bleed as much, and I was trying to accommodate, though the risk would be hypotension.  Throughout most of the case I was successful in walking the fine line of hemodynamics, though at one point the patient seemed a bit bradycardic (heart rate of 46, baseline of 60, running most of the case in the 50’s) and hypotensive.  I gave a dose of ephedrine and a little fluid, and explained to the medical student my rationale as we watched the monitors for the response.

Just then, I heard a voice say, “The patient is bradycardic.”  I turned around.  It was a woman who had been one of the two or three people floating mysteriously on the periphery of the room; she was now standing immediately behind me.

Rather than answering her, I asked, again with a neutral tone, “Excuse me, who are you?” “I’m with the liver transplant team, but I used to be an ICU nurse,” she replied.

I then asked her, “Are you asking me or telling me that the patient is bradycardic?”  She said nothing, so I turned around and went back to my job of taking care of the patient.

I think the thing I found particularly insulting is what this former ICU nurse’s interference with my work implied.  If I’d been sitting there working on a crossword puzzle while the patient was on the brink of death, that is one thing.  But I was clearly monitoring the patient, so this woman’s comment suggested that I was not qualified to recognize a problem.  This I found highly offensive.  This is my job.  I monitor patients.  I keep them alive while the surgeons hack out major organs. Not only did I already knowthe patient was bradycardic (not so worrisome) and hypotensive (more concerning), I had already treated it by the time this woman thrust herself into my area of sanity on my side of the drapes.

I will spare my gentle readers the story from the same day of the animal, er, older man, who resorted to pushing on the subway when people were in his way, rather than walking around or *gasp* saying “excuse me.”

I don’t know…maybe I’m the arrogant, dismissive one.  But better to be clever and arrogant and dismissive, than foolishly arrogant.

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Doctors as professionals

I ran across this interesting post recently which contrasts physicians with other professionals.

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