Respect

Orders. That’s what we doctors give to nurses, technologists, and other so-called ‘ancillary’ healthcare workers. We’re telling, not asking, them to do something our patient needs. That’s how the system works, and for good reason—someone has to sit in the director’s chair and maintain consistent vision.

Like the military, medicine has a hierarchy, clearly defined and known to all. This promotes efficiency, delineates responsibilities, and generally functions well. Communication lines are set; players know their boundaries. The accepted argot does not rely on niceties, and everybody’s fine with that.

Too often, though, it seems power really does corrupt: doctors behave badly, treating those below them on the ladder with scorn and condescension. Yes, we work too many hours, we stay up all night on call or miss our kids’ games because we’re in the OR, we don’t have time or energy to exercise, and we are ever mindful that the buck stops smack on top of us. We’ve spent a big chunk of our lives in school, and we know an amazing amount of stuff. But that doesn’t make us gods, or entitle us to act like jerks.

Recently a colleague blew up at one of our techs. She’d been trying to help him with an urgent scan, and pointed out an error in his order. Later he apologized, sort of, but insisted that his rank trumped all and should have been respected.

Rudeness is popping out all over these days, not just in medicine. Like other nasty things, it tends to be contagious, and little lapses can have larger consequences—studies have shown, for example, that patient outcomes are worse in ICUs where incivility is rampant.

Perhaps our culture needs to step back, do a little yoga breathing, and get our collective blood pressure down a notch or two. Courtesy isn’t just a virtue, it’s crucial for society to function. Respect is definitely a two-way street.

The biggest leaf in the forest

This fall they are enormous. Leaves like dinner plates at every turn, gold and brown and yellow, all but eclipse the forest floor. Each seems larger than the last, and I scramble from one to the next in disbelief: how big can these monsters be? This sets me on a quest to find the largest, the king of maple leaves, in all Fall Creek. That’s no small challenge, since miles and miles of trails percolate through the redwoods in this corner of the universe.

I’ve got food, and water, and all day to be nowhere but here. I head off light as laughter, free of cell phones, computers, and concerns. My digital camera, sole remnant of the world that ended at the parking lot, is both companion and accomplice. The sun on its morning course paints impressionistic arcs onto the duff as it works to penetrate the mat of branches overhead. It’s a canvas to get lost in, beyond time and memory. The camera and I step off the edge together, deep into the heart of it.

Hours, or maybe days, later I emerge, clutching my leafy treasure and heading wearily toward the parking lot. I’m thirsty, hot, and spent. My feet berate my intemperance, as does my stomach—I’ve drunk all my water and eaten all my snacks some time ago. All I want is to get these boots off and sit down somewhere soft and comfy, but it’s still a half-mile to the car.

Did you took a picture of your fun leaf? The voice is high and small, and takes me by surprise: I’d been looking down at the trail, and hadn’t noticed the child and her mother coming toward me. The three massive gilded leaves I held in one hand, the camera in the other, and the magic they contained were all but forgotten. I looked up and met her open, milk-toothed smile. ‘Yes,’ I told her. ‘Yes, I did.’

The small stuff

Don’t sweat the small stuff, don’t lose the forest for the trees–great advice, generally. But little things sometimes make all the difference, as I’ve learned in both my profession and my passion.

My day job is radiology. I sit before a bank of flat screens and look at x-rays, ultrasounds, CTs, and MRIs—thousands of images a day. Each must be evaluated carefully, on its own and with its fellows, for every case. Often there’s just one that shows the crucial finding—an errant lymph node, a wedge of fluid where none belongs, a wayward spot in an unsuspecting brain. Sometimes it’s what we call a ‘corner shot,’ a flicker at the edge of vision. Far from the center of attention, like a kidney mass on the last image of a chest CT, these may be overlooked. Every detail, though, is created equal in my world, and as such must be respected. Of course, that doesn’t mean losing sight of the patient. Getting these details right is a necessary first step to seeing the whole picture.

Photography, my other occupation, is no different. Here too every detail counts, from gear to composition. Did I set the aperture right for the depth of field I wanted? What about the exposure comp? Did I remember to charge my spare batteries? Will this scene look better as a vertical, or a horizontal? And do I want a fast shutter, a slow one, or something in between? The crucial question is this: what image do I hold in my head, what am I striving to create? Sure, some things can be tweaked in Photoshop, but the fundamentals must be right before the shutter snaps.

Though I love the vastness of the forest, I recognize the value of each tree—not to lose myself in, but as pieces of that prized larger picture. That small stuff can be pretty big.

The last tomato

I should have done it weeks ago, but I just couldn’t. Now it’s mid-November, and I can’t ignore it any longer. Summer is long gone, and fall not far behind: there will be no more tomatoes, and the vines must go.

They are tall and proud, if a bit wilted and yellow with the turn of seasons, somehow still putting forth new flower trusses despite the cold. I hate to take them down, but I need the space for another crop. So I snip the ties that bind them to their cages, support for fruit long since harvested and eaten. I disentangle branches from the wires, and pull the cages free. The vines collapse like swooning gentlewomen, prostrate and dramatic. I kneel down and begin to turn the earth, cleaving root from soil and making sure that none remains. There is no going back.

Soon enough the roots are free, as much soil shaken or massaged loose as I can manage, and the vines are all unmoored. I’m about to toss them to the compost when I spot a pale green orb, about the size of a key lime, clinging to one fallen lady’s skirts. Carefully, tenderly, I pluck it from the stem and put it in my pocket. This is the last tomato, summer’s final shout of joy and lust. It whispers like an emerald—alluring, secretive, and precious.

Demon Wheels

Much as I love the ease, I am convinced my wheeled suitcase is the devil’s work. Capacious and accommodating, it entices me to make use of all that empty space—and so I do. I pile in clothes I know I won’t need, shoes I know I won’t wear, and books I know I won’t read on my trip. But why not—there’s plenty of room in there! And since I have to check a bag, I might as well fill it.

By the time the void is filled, I can barely lift the suitcase. It’s below the weight limit for extra fees, though not in any meaningful way. Thence springs our love-hate relationship: those little wheels mean I don’t have to carry it, so I am free to abandon the idea of traveling light. Those little wheels mean I can give in to the American way of excess without consequence, despite my best intentions.

Sit in any airport terminal for five minutes, and you’ll see this submission is nearly universal—the relentless clack of small plastic wheels against floor tiles marks our collective embrace of convenience. In itself that isn’t evil, but the intense desire to avoid anything requiring effort is another story.

Our unwillingness to exert ourselves, even in a small thing like carrying our own suitcases, does not suggest openness to solving problems that may call for sacrifice and self-restraint along with inconvenience. Climate change and the obesity epidemic come to mind, perhaps because I’m watching the American parade while waiting for a flight.

Next time I travel, I promise myself, I will pack only what I can carry under my own steam—and so restrict myself to what is truly needed. Will that solve the planet’s woes? Of course not; it won’t even solve mine. But it will make me feel more self-reliant, and less slothful. As for the suitcase, it may feel rejected, but that weight I can easily shrug off.

The weight of water

It flows, colorless and clear, weightless till you try to carry it. Each gallon tips the scale at 8.35 pounds and change, a number that’s abstract to most of us—why should we know, or care about, the weight of water?

This summer, as the state’s edges curl and crisp from a 3rd year of drought, I’ve been thinking about water quite a lot. More precisely, I’ve been thinking about how much of it I waste.

There’s a fair amount of low-hanging fruit, and I’ve picked it. Most Californians know the classic water-saving mantra ‘if it’s yellow, be mellow’. Running the dishwasher and washing machine only when full and turning off the water while brushing teeth are easy too. Converting to drip irrigation, and installing rain sensors on sprinkler systems, is harder, but still in reach.

My house was built long before rainwater harvesting or greywater recycling entered the lexicon, so it’s not exactly green—and retrofitting only goes so far. Water from my shower, bathroom sinks, and washer drains into the septic tank, eventually to leach out into a corner of the yard. How much better, I thought, if some could be recaptured?

So I bought buckets, small ones for the bathrooms and the kitchen, and a large one for the shower, and proceeded to collect water. Even being hyper-conscious of my usage, the amount I was harvesting each day was horrifying. What brought it home was when I carried it outside to lavish on my garden: this is heavy!

Hefting the shower bucket, I pictured 3rd world women lining up for water, carrying filled jars on their heads as they trudge along a dusty path, miles from home. We simply turn on a tap, and out comes clear, clean, life—costing practically nothing. Maybe that’s the problem: it’s too easy, and too cheap.

I know my small efforts won’t save the planet, or even the state. But if more of us understood the weight of water, and its value, it would be a great start.

Radio day

This morning I had a mini adventure….went to the studios of KQED, the San Francisco NPR and PBS station, to record two essays that will be aired as commentaries in the coming weeks. Both are shortened versions of posts on this blog. The first, ‘Lost Arts’, will air this coming Monday (9/14) at either 6:06 or 7:35 AM Pacific time @ 88.5 FM. You can also catch their live stream on the website. Finally, you can subscribe to the podcast or RSS for the commentary series, which is called Perspectives, here.

Once I got there, having fretted about being late due to unexpected traffic snarls, it was a fun experience. The engineer and editor were super cool and low key. I got each piece laid down in a single take, which made everyone happy–especially me, since I was a little nervous.

When I have an air date for the second piece, ‘One Ridge Away’, I’ll post it here.

Enjoy!

Escalation

When this whole thing started, I didn’t know an acorn woodpecker from a pileated one, or a house finch from a chickadee. I have indoor cats, and a window-mounted bird feeder seemed a great amusement for them: low cost, fun for all, no one gets hurt.

It was a huge hit, with cats and birds alike. Birds, though, are not the neatest diners in the world, and a good portion of the seed was scattered to the deck below. This is when the squirrels moved in, scrabbling nervously across the redwood planks to vacuum up the fallen bounty. The cats loved this too, and I judged it an added bonus till the squirrels began pole-vaulting onto the feeder, knocking it—seeds and all—off the glass.

My counter was a bowl, set on the deck, filled with cracked corn and peanuts in the shell—loot the bag of ‘critter delight’ promised would distract them from the birdseed. It did. It also delighted birds too bulky or too heavy for the window feeder—2 kinds of jays, woodpeckers, and massive band-tailed pigeons. I felt bad for the squirrels, crowded out in turn by new invaders.

The next salvo was a wire basket filled with suet cakes: molded blocks of shredded beef fat mixed with bits of insects, nuts, or fruits that are completely vile, unless you happen to have wings. It was an overnight sensation: the jays and other pushy birds took to it like magic.

By this point, cats, squirrels, and various assorted feathered friends were all ecstatic. I was less so, with my morning routine expanded by the frequent need to restock everything. These weren’t even birds I really liked, if truth be told.

The solution, of course, was yet another feeder: this time for hummingbirds, which I dearly love. Now when I’m out at dawn wrangling a greasy mass of suet into its cage, or topping off the squirrels’ trove, I listen for insistent tiny wings. They buzz right by my ear, bold and iridescent, and I smile.

One ridge away

The first day, it eats 3000 acres, rejoicing over hills and into canyons. The forest belches slabs of orange smoke, which float south raining ash. One ridge from my house, fire leaps and sings and multiplies.

That afternoon, I drive north to a meeting through air that’s hot and cracked around the edges. Red trucks caravan south on highway 17, Cal Fire troops from every corner bound for the inferno. I give each a broad thumbs-up, streaming tears of gratitude. Help is on the way, I tell my mountains silently: they are coming.

My tears recall the first anniversary of 9-11. I passed a firehouse that morning, and saw uniformed firemen standing at attention. Their engines made a sleek red row, noses to the street. I stopped at a market and bought armfuls of red, white, and blue flowers, drove back, and thrust them wordlessly at the men. We all hugged and cried, remembering prodigious courage, loss, and struggle.

Those who fight this day, on the Lockheed fire and others, are largely unsung heroes. On my deck, I listen to aircraft crisscrossing the ridge, and try to apprehend the smoke, fatigue, and heat the fire crews endure. I can go inside, where iced green tea awaits. They cannot escape so easily, nor would they wish to—these are truly men, and women, to match mountains. They will not quit till fire has been brought to ground, starved and soaked and chopped into submission.

Wind drives the blaze southwest, away from me and toward other houses. I am relieved, but not light-hearted: those other people, animals, and trees are all my neighbors. In the mountains—and, it could be said, in all of life, we are all one ridge away from devastation, and what spares one may destroy another. We take for granted the thin line that shields us as we go about our lives, oblivious and free. Next time you see a firefighter, or your personal variety of hero, take one true and simple moment to say: thank you.

Ruthless

I am too soft to be a gardener. I don’t mean I’m out of shape, or scared of dirt under my nails. What I balk at is the killing. Gardening by nature invites life, celebrating bounty and diversity. What could be more nurturing than planting seeds? It turns out there’s a flip side, as with so many things.

You’ve studied the seed catalogs and received your choices, or maybe you stashed some seeds from last year’s harvest—the melon that made your knees go liquid, the tomato everyone was begging for. You nestle each seed in the bed, prepared with rich organic soil and a good dose of compost. You water them devotedly, waiting anxiously for germination. The first few days are carefree, but around the time they should be sprouting you begin to fret and hover. No excuse is too small to go outside and check for miniscule green shoots: is today the day? Is now the very hour? When you find it isn’t, you slink inside certain they are doomed, for you have watered them too much—or perhaps too little.

At last you do see signs of life, tiny fearless tips of green cresting the surface, and it feels like party time: they’re alive! I didn’t kill them after all—or at least not yet. For soon you will kill them, some of them anyway, and quite deliberately.

My carrots came up right on schedule, frilly little shoots that embodied the idea of green. I was so proud you’d think I’d made the seeds myself, or worked some major magic in their birthing. Everything was perfect, and everyone was happy, for about 10 days. Thin when shoots are 1-2” tall, the seed packet said. Soon enough, I had to admit it was time.

Carrots, you may know, don’t like to be disturbed once rooted, so it’s typical to start from seed instead of transplants. The seeds are tiny, and they won’t all germinate, so you plant more seeds—and closer together—than there’s room for. At some point, then, you will be forced to choose: which will live, and which will die?

I scan the rows of seedlings for some sign to tell the weak ones from the strong, but there is absolutely nothing. In the end it’s pure geography: each plant needs its proper space, so I just cull enough to ease the crowding. Instead of tossing them aside, though, I plant each uprooted seedling elsewhere in the bed. I know they probably won’t take, but at least I’ve tried to save them. And now I’ve got a new excuse to hover.